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Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease.

Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
Arquivos Brasileiros de Cardiologia (Impact Factor: 1.12). 05/2004; 82(4):337-45.
Source: PubMed

ABSTRACT To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease.
Thirty-three (67% were women) patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3+/-10 years, preoperative NYHA functional class was 3.2+/-0.6, left atrial size was 5.5+/-0.9 cm, and ejection fraction was 61.3+/-13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left atrial appendage, and a perpendicular incision originating in the inferior margin of the circumferential incision isolating the pulmonary veins down to the mitral valve. Early arrhythmias were aggressively treated with cardioversion.
The mean follow-up was 23.9+/-17 months, and 3 patients died in the postoperative period. Ten patients required electrical cardioversion in the postoperative period; 87% had sinus rhythm in the last medical visit, and 33% were using amiodarone.
Isolation of the pulmonary veins associated with mitral valve surgery is an effective and safe technique for maintaining sinus rhythm in patients with permanent atrial fibrillation.

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Available from: Tiago Leiria, Jun 15, 2014
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    ABSTRACT: To evaluate the chronotropic response to exercise during immediate and late postoperative period after atrial fibrillation and mitral valve surgical treatment by different techniques. Prospective controlled clinical study of 42 patients presenting chronic AF associated mitral valve disease, who underwent surgery by the techniques of pulmonary veins isolation (n=16), Modified Cox-maze procedure, without cryoablation (n=13), both with isolated mitral valve repair (n=13). The preoperative clinical characteristics, surgical indications, kind and aetiology of valve lesion were similar between groups. The patients were outpatient followed-up and underwent series of ergometric tests. In the immediate postoperative period, chronotropic response was similar in the 3 groups with mean of 73.6 +/- 12.3% of maximal calculated heart rate. In the surgical pulmonary veins isolation group, there was an increment of heart rate, from 64.4 +/- 12.4% of maximal heart rate in the immediate postoperative period to 78.9 +/- 10.5% in the 12th month (P=0.012) of postoperative. In the Cox-maze group, heart rate varied, respectively, from 73.9 +/- 11.14% to 78.8 +/- 15.2% (P=1.000) and in the control group (only mitral valve surgery), from 67.2 +/- 14.3% to 71.9 +/- 12.9% (P=0.889). An attenuation of immediate postoperative chronotropic response to exercise was similar in the postoperative in the three different surgical techniques. There was a significant improvement in this response concerning to postoperative outcome in the pulmonary veins isolation group. These results suggest that simple surgical pulmonary veins isolation may be related to a better preservation of atrial chronotropism.
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    ABSTRACT: Objective: To evaluate the chronotropic response to exercise during immediate and late postoperative period after atrial fibrillation and mitral valve surgical treatment by different techniques. Methods: Prospective controlled clinical study of 42 patients presenting chronic AF associated mitral valve disease, who underwent surgery by the techniques of pulmonary veins isolation (n=16), Modified Cox-maze procedure, without crioablation (n=13), both with isolated mitral valve repair (n=13). The preoperative clinical characteristics, surgical indications, kind and aetiology of valve lesion were similar between groups. The patients were outpatient followed-up and underwent series of ergometric tests. Results: In the immediate postoperative period, chronotropic response was similar in the 3 groups with mean of 73.6 ± 12.3% of maximal calculated heart rate. In the surgical pulmonary veins isolation group, there was an increment of heart rate, from 64.4 ± 12.4% of maximal heart rate in the immediate postoperative period to 78.9 ± 10.5% in the 12 th month (P=0.012) of postoperative. In the Cox- maze group, heart rate varied, respectively, from 73.9 ± 11.14% to 78.8 ± 15.2% P=1.000) and in the control group (only mitral valve surgery), from 67.2 ± 14.3% to 71.9 ± 12.9% (P=0.889). Conclusion: An attenuation of immediate postoperative chronotropic response to exercise was similar in the postoperative in the three different surgical techniques. There was a significant improvement in this response concerning to postoperative outcome in the pulmonary veins isolation group. These results suggest that simple surgical pulmonary veins isolation may be related to a better preservation of atrial chronotropism.