Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery

Kim, Ho Jin; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

doi:10.1136/heartjnl-2015-308482

Cited by 18 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are few studies investigating clinical outcomes associated with SND after concomitant surgical AF ablation and MV surgery. SND is considered to decrease in duration, intensity, and frequency in a time-dependent manner during the first 6 months after surgery [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…Yuda et al[ 15 ] reported restoration of sinus rhythm in 58% of patients with giant left atrium (LAdia≥ 60 mm in B mode echocardiography) at 12 months compared with 81% in patients without giant left atrium. On the other hand, Kim et al[ 14 ] demonstrated good results of concomitant surgical ablation of giant left atrium (LAdia > 60 mm) (freedom from AF: 68.9% in the MAZE group vs. 9.6% in the no MAZE group). Various rhythm monitoring strategies, surgical experience, and different patient populations could have contributed to these heterogeneous results.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The discrepancy to our results additionally indicates that success rates may be largely overestimated when excluding the deceased patients. Two cohort studies cumulatively estimated the incidence of recurrence without reporting AAD treatment in SAF patients undergoing CMIV (52.7%) or no ablation,[ 22 ] and PAF/SAF patients receiving left-sided CMIV,[ 20 ]. Freedom from recurrence was 75.4% and 65.4–68.9% after 2 and 5 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated that maze III/IV lesions are successful in obtaining sinus rhythm (SR),[ [8] , [9] , [10] , [11] , [12] , [13] ] regardless of whether they were performed as a stand-alone or concomitant procedure,[ [14] , [15] , [16] ]. However, studies investigating the efficacy of maze IV differ in terms of study design and settings leading to heterogeneous short- and long-term rates of freedom from AF recurrence between 47 and 94%,[ 8 , 12 , [17] , [18] , [19] , [20] ] and 56–91%,[ 9 , 18 , [21] , [22] , [23] , [24] ], respectively. Consequently, predictors of recurrence also are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

The long-term efficacy of concomitant maze IV surgery in patients with atrial fibrillation

Engelsgaard

Riber

et al. 2018

IJC Heart & Vasculature

View full text Add to dashboard Cite

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia, and associated with increased risk of morbidity and mortality. AF surgery is widely used for rhythm control of AF, but previous studies have shown varying results. This study sought to investigate the long-term efficacy of concomitant maze IV (CMIV) surgery in an unselected AF population and identify predictors of late AF recurrence.MethodsIn total 144 consecutive patients, who underwent CMIV between January 2006 and December 2010 were enrolled. By data from electronic medical records, registers, and rhythm prints, late AF recurrences and heart rhythm at latest follow-up were retrospectively registered. All patients still alive were invited to an ambulant follow-up to update rhythm status.ResultsDuring a median (IQR) follow-up of 7.39 (2.67) years, 114 (79.2%) patients had recurrence. The cumulative incidence of sinus rhythm (SR) without antiarrhythmic drugs (AADs) was 52.3% after 1 year. Long-term results after 2, 5 and 7 years were 47.9%, 32.6% and 25.1%, respectively. At latest follow-up 34.7% were in SR off AADs. No difference in 10-year event-free survival stratified by recurrence were found (p = 0.678). Contrary, time to death (5.40 vs. 3.43 years, p = 0.004) revealed death as competing risk event. The Fine-Gray model identified preoperative sustained AF (SAF) (SHR 3.54, 95%CI [2.35;5.32], p < 0.001), AF duration (1.08, [1.05;1.11], p < 0.001), and postoperative atrial tachyarrhythmia (ATA) (2.29, [1.21;4.35], p = 0.011) as predictors.ConclusionCMIV in the present cohort provided limited long-term success in obtaining SR. SAF, longer AF duration, and postoperative ATA were associated with late AF recurrence.

show abstract

“…15 Iní autori potvrdzujú zväčšenie LA (veľkosť LA > 60 mm) ako rizikový faktor zlyhania procedúry MAZE (p < 0,05, OR 1,72, 95% CI 1,05-2,81). 16 Výsledky prezentovanej štúdie dokumentujú rozmer LA ako rizikový faktor pre POAF (p = 0,01), tak aj PPOAF (p < 0,01). Údaje potvrdzujú, že rozmer LA je prediktorom dysfunkcie LA s následnou poruchou vedenia vzruchu.…”

Section: Diskusiaunclassified

(The effect of cardiac venting technique for aortic valve replacement surgery on the incidence of postoperative atrial fibrillation)

Toporcer¹,

Kraus²,

Grendel³

et al. 2019

Cor Vasa

View full text Add to dashboard Cite

Fibrilácia predsiení (AF) je najčastejšou komplikáciou po operácii srdca. Len niekoľko štúdií popisuje incidenciu a rizikové faktory pooperačnej fi brilácie predsiení (POAF) po izolovanej operácii aortálnej chlopne (AVR). Dôležité je aj to, že miesto zavedenia ventu počas AVR môže vytvoriť lokality s pomalým vedením vzruchu, čo predstavuje substrát pre vznik re-entry. Cieľom štúdie je porovnať vplyv techniky zavedenia ventu cez truncus pulmonalis (PA) a pulmonálnu žilu (PV) počas AVR na incidenciu POAF. Do retrospektívnej štúdie boli zaradení pacienti (n = 497) podstupujúci izolovanú AVR, okrem pacientov s predoperačnou permanentnou AF alebo implantovaným kardiostimulátorom. Použitie techniky ventovania srdca cez PV v porovnaní s ventom cez PA je spojené so signifi kantnou prolongáciou času mimotelového obehu o 10,6 minúty (p < 0,0001, 95 % CI 7,76-13,35), času svorky aorty o 7,7 minúty (p < 0,0001, 95% CI 5,34-10,16), predĺžením pobytu pacienta na jednotke intenzívnej starostlivosti o jeden deň (p = 0,0025, 95% CI 0,34-1,56) a času hospitalizácie o 1,4 dňa (p = 0,003, 95% CI 0,34-2,23). Skupina pacientov s ventom zavedeným cez PV vykazovala v porovnaní s pacientmi s ventom cez PA 32%-ný relatívny nárast incidencie POAF (34 %-PA, 45 %-PV, p = 0,03). Univariačná logistická regresná analýza identifi kovala implantáciu ventu cez PV ako rizikový faktor vzniku POAF (p = 0,04, OR 1,50, 95% CI 1,02-2,22).

show abstract

Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery

Abstract: The concomitant maze procedure improved postoperative rhythm status, clinical outcomes and cardiac functions in patients with a giant LA undergoing MV surgery. This study indicates that the patients with a giant LA undergoing MV surgery may benefit from an addition of the maze procedure.

Cited by 18 publications

References 30 publications

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

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

The long-term efficacy of concomitant maze IV surgery in patients with atrial fibrillation

(The effect of cardiac venting technique for aortic valve replacement surgery on the incidence of postoperative atrial fibrillation)

Contact Info

Product

Resources

About