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Ann Thorac Surg 2002;73:1169-1173
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Simple surgical isolation of pulmonary veins for treating secondary atrial fibrillation in mitral valve disease1

Renato A.K. Kalil, MD, PhD*a, Gustavo G. Lima, MD, MSca, Tiago L.L. Leiria, MDa, Rogério Abrahão, MDa, Leonardo M. Pires, MDa, Paulo R. Prates, MDa, Ivo A. Nesralla, MD, PhD

a Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Brazil

Accepted for publication November 28, 2001.

* Address reprint requests to Dr Kalil, Instituto de Cardiologia do Rio Grande do Sul, Unidade de Pesquisa, Av. Princesa Isabel, 395 Santana, Porto Alegre, 90.620-001, Brazil
e-mail: pesquisa{at}cardnet.tche.br

Background. hronic atrial fibrillation (AF) due to mitral valve disease has been successfully treated by surgery. We performed a study to evaluate the effectiveness of a surgical method of simple pulmonary vein isolation (PVI) without radiofrequency or cryoablation in the restoration of sinus rhythm in a group of patients.

Methods. Fifteen patients were operated on for mitral valve disease and chronic AF. The technique consists basically of a circumferential incision excluding the pulmonary vein ostia from the left atrium.

Results. Sinus rhythm was achieved in 92.3% of the patients at 6-month follow-up. Echocardiograms 2 months after surgery showed a mean decrease of 1.1 cm in left atrial size. Effective atrial ejection was reestablished in all patients in whom sinus rhythm was achieved (mean LA ejection fraction 41% ± 14%). Twenty-four hour Holter recordings did not show episodes of paroxysmal atrial fibrillation in any patients. Four patients had isolated episodes of ventricular ectopic beats. Stress electrocardiograms showed mean maximal ventricular response was 64% ± 11% and 73% ± 9% of predicted value at 2 and 6 months, respectively. All patients had improved NYHA functional class after surgery; 74% of patients were in NYHA functional class I at 6 months compared with 13.3% preoperatively.

Conclusions. Pulmonary vein isolation without the use of radiofrequency or cryoablation is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease. Based on simple surgical incisions, this technique is more advantageous than others requiring additional instrumentation.




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