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Ann Thorac Surg 2005;79:108-112
© 2005 The Society of Thoracic Surgeons
a Department of Cardiology
b Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqwa, Israel, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Accepted for publication June 16, 2004.
* Address reprint requests to Dr Raanani, Department of Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel 52621 (E-mail: ehud.raanani{at}sheba.health.gov.il).
Presented at the Poster Session of the Fortieth Annual Meeting of The Society for Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
BACKGROUND: Left atrial radiofrequency ablation is the most common technique for the treatment of atrial fibrillation during mitral valve surgery. Reported failure rates range between 15% and 30%, with some patients remaining in atrial fibrillation and others experiencing atrial flutter. The incidence and nature of the postoperative atrial flutter is not yet well defined.
METHODS: The study group consisted of 50 patients with atrial fibrillation who underwent mitral valve surgery combined with left atrial radiofrequency ablation, and were followed for a mean period of 15 ± 7 months. The majority of patients (39; 78%) had persistent or permanent atrial fibrillation. Placement of the ablation lines was as follows: encircling the pulmonary veins, isolating the base of the left atrial appendage, and bridging the lateral or posterior mitral annulus and the margin of the pulmonary vein or the appendage-encircling ablation lines.
RESULTS: There were three hospital deaths (6%). Thirty-four (72%) patients were free of any atrial tachyarrhythmia events, and 37 (79%) patients were in sinus rhythm by the end of the study's follow-up. During the follow-up, 6 patients (12.7%) experienced atrial flutter and 1 patient had atrial tachycardia. Electrophysiologic study was performed in 5 of 6 patients with postoperative atrial flutter. In 4 of them, the study findings were consistent with left atrial flutter. One patient with typical isthmus-dependent right atrial flutter underwent successful ablation.
CONCLUSIONS: Left atrial surgical radiofrequency ablation is associated with a high rate of postoperative atrial flutters that appear to be predominantly of left-sided origin.
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