Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes

Abstract

ObjectiveWe sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied.Study design and settingSND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery.ResultsPatients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m2; 95% confidence interval (CI): 1.0206–1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002].ConclusionsIn conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

“…In previous studies, several risk factors or predictors of SND after termination of AF have been reported, including older age, a female gender, a low preprocedural ventricular rate, and a large left atrium [ 24 , 28 , 29 , 30 , 31 , 32 ]. The present study found that age, female gender, and the underlying history of hypothyroidism were predictive of SND after AFL ablation.…”

Bi-atrial versus left atrial ablation for patients with rheumatic mitral valve disease and non-paroxysmal atrial fibrillation (ABLATION): rationale, design and study protocol for a multicentre randomised controlled trial

“…However, Cox et al believe that there are many reasons for permanent pacemaker implantation after surgery, but standardised right atrial ablation set do not increase the risk of permanent pacemaker implantation 35 36. Other studies displayed LA fibrosis or dilation was associated with sinus node dysfunction requiring pacemaker implant 37 38. Nevertheless, previous meta-analyses showed that the additional right atrial ablation increased the risk of permanent pacemaker implantation 24.…”

Cardiac Paraganglioma in a 14-Year-Old

“…12 The sinus node artery can be severed either by the right atriotomy in the right coronary fossa or by the left atrial incision. 13 Most cases of postoperative sinus node dysfunction are transient. However, it can be prolonged or permanent, like in our patient.…”