Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease
ABSTRACT Although the Cox-Maze III procedure is effective for treating permanent atrial fibrillation (AF), its high complexity limits its use. The Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) System is an alternative source of energy used to ablate AF. The aim of this study was to evaluate the effectiveness of the SICTRA for the treatment of permanent AF in patients with rheumatic mitral valve (MV) disease.
Between February 2002 and April 2003, 70 patients with permanent AF and rheumatic MV disease were randomly assigned to undergo a modified Maze III procedure using SICTRA associated with MV surgery (group A) or MV surgery alone (group B). Groups A and B were similar in terms of baseline characteristics. The in-hospital mortality rate was 2.3% (1 death) in group A versus 0% (no deaths) in group B (P>0.99). The additional time required for the left-sided radiofrequency ablation in group A was 14.2+/-5.1 minutes and for right-sided ablation was 12.3+/-4.2 minutes. The mean postoperative follow-up periods were 13.8+/-3.4 and 11.5+/-7.3 months, respectively, in groups A and B. The overall mid-term survival rate was 95.1% in group A and 92.8% in group B (P>0.99). The cumulative rates of sinus rhythm were 79.4% in group A and 26.9% in group B (P=0.001). Doppler echocardiography documented biatrial transport function in 90.3% of group A patients in sinus rhythm.
The SICTRA is effective for treating permanent AF associated with rheumatic MV disease.
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ABSTRACT: Atrial fibrillation (AF) is present in 30-40% of patients presenting for mitral valve surgery. In patients undergoing mitral valve repair, the presence of AF may be associated with increased mortality and morbidity and this is also the case in patients in whom AF persists postoperatively. Advances in understanding the pathogenesis of AF led to techniques that include both mitral valve repair and ablation of AF. The concomitant surgical treatment of AF during mitral surgery has become a commonly performed procedure, which was shown to be safe and which may improve the outcome for patients. AF after mitral valve replacement is an accepted indication for anticoagulation, but the data supporting anticoagulation in patients after mitral valverepair who convert to sinus rhythm are sparse. This article reviews the available data regarding outcomes of mitral repair and how they are influenced by AF and its therapy.Pacing and Clinical Electrophysiology 09/2008; 31(8):1057-63. DOI:10.1111/j.1540-8159.2008.01135.x · 1.25 Impact Factor
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ABSTRACT: Various lesion sets and subsequent success rates have been reported in patients receiving concomitant surgical ablation for atrial fibrillation. However, most of these results have been obtained by discontinuous monitoring. We report results using continuous event recorder rhythm monitoring to compare more accurately the efficacy of a left versus biatrial lesion set to treat patients with persistent atrial fibrillation. Between July 2008 and December 2011, 66 patients with persistent or long-standing persistent atrial fibrillation underwent concomitant surgical atrial fibrillation ablation with a biatrial lesion set and subcutaneous event recorder implantation. The results and outcomes were compared with a propensity score-matched cohort of 66 patients with a left atrial lesion set and event recorder implantation. Event recorder interrogation was performed at 3, 6, and 12 months follow-up. The mean patient age was 70.2 ± 7.4 years, and 70.3% were male. No major ablation-related complications occurred. One-year survival was 94.8% with no statistically significant differences between the 2 groups. The overall rate of freedom from atrial fibrillation was 57.3% and 64.4% after 3 and 12 months follow-up, respectively. Three months postoperatively, patients in the biatrial group had a slightly higher rate of freedom from atrial fibrillation (63.6% vs 52.3% P = .22), but it did not reach statistical significance. At 12 months follow-up, a statistically significant higher rate of freedom from atrial fibrillation was observed in patients with a biatrial lesion set (74.4% vs 55.8%; P = .026). The mean atrial fibrillation burden in all patients was 15.1% ± 12.5% in the biatrial group and 21.2% ± 14.4% in the left atrial group 12 months postoperatively (P = .03). Continuous rhythm monitoring by subcutaneous event recorder implantation was safe and feasible. In patients undergoing biatrial ablation, a statistically significant higher rate of freedom from atrial fibrillation was observed at 12 months follow-up.The Journal of thoracic and cardiovascular surgery 02/2014; 148(5). DOI:10.1016/j.jtcvs.2014.02.061 · 3.99 Impact Factor