ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Discussion
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Faisal Bakaeen
Patrick M. McCarthy
Eugene H. Blackstone
Gosta Pettersson
Joseph F. Sabik, III
Farzad Najam
Kathleen M. Hill
Lars G. Svensson
Delos M. Cosgrove
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gillinov, A. M.
Right arrow Articles by Natale, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gillinov, A. M.
Right arrow Articles by Natale, A.
Related Collections
Right arrow Electrophysiology - arrhythmias

Ann Thorac Surg 2006;81:19-28
© 2006 The Society of Thoracic Surgeons

J. Maxwell Chamberlain memorial paper

Surgery for Paroxysmal Atrial Fibrillation in the Setting of Mitral Valve Disease: A Role for Pulmonary Vein Isolation?

A. Marc Gillinov, MD a , b , * , Faisal Bakaeen, MD a , b , Patrick M. McCarthy, MD a , b , Eugene H. Blackstone, MD a , b , c , Jeevanantham Rajeswaran, MS c , Gosta Pettersson, MD, PhD a , b , Joseph F. Sabik, III, MD a , b , Farzad Najam, MD a , b , Kathleen M. Hill, RN a , b , Lars G. Svensson, MD, PhD a , b , Delos M. Cosgrove, MD a , b , Nassir Marrouche, MD c , d , Andrea Natale, MD c , d

a Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio
b Departments of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
c Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio
d Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio

Accepted for publication April 26, 2005.

* Address correspondence to Dr Gillinov, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F24, 9500 Euclid Ave, Cleveland, OH 44195 (Email: gillinom{at}ccf.org).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005. Winner of the J. Maxwell Chamberlain Memorial Award for Adult Cardiac Surgery.

BACKGROUND: It is unknown whether pulmonary vein isolation or a complete Cox-Maze procedure is needed to ablate paroxysmal atrial fibrillation in patients with mitral valve disease. Our objective was to assess the impact of different surgical treatments for this arrhythmia in patients undergoing mitral valve surgery.

METHODS: From July 1993 to January 2004, 152 patients underwent combined surgical treatment of paroxysmal atrial fibrillation and mitral valve disease. Ablation procedures included pulmonary vein isolation alone (n = 31, 20%), pulmonary vein isolation with left atrial connecting lesions (n = 80, 53%), and Cox-Maze (n = 41, 27%). The latter had longer durations of atrial fibrillation than the former (p < 0.0001). Rhythm documented on 1,225 postoperative electrocardiograms was used to estimate prevalence of, and risk factors for, atrial fibrillation across time. Ablation failure was defined as occurrence of atrial fibrillation any time beyond 6 months after operation.

RESULTS: Prevalence of postoperative atrial fibrillation peaked at 22% at 2 weeks and declined to 9% at 1 year. Risk factors included older age (p = 0.09), larger left atrium (p = 0.05), and rheumatic (p = 0.003) and degenerative etiologies (p = 0.03). Freedom from ablation failure was 84% at one year. Ablation procedure did not affect prevalence of atrial fibrillation or incidence of ablation failure.

CONCLUSIONS: Pulmonary vein isolation alone may be adequate treatment for patients with paroxysmal atrial fibrillation undergoing mitral valve surgery, particularly when it is of short duration. A randomized trial is necessary to examine this strategy, especially in patients with longer duration of paroxysmal atrial fibrillation.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
P. B. Rahmanian, J. G. Castillo, D. Mehta, D. H. Adams, and F. Filsoufi
Epicardial Pulmonary Vein Isolation: A Long-Term Histologic and Imaging Animal Study Comparing Cryothermy Versus Radiofrequency
Ann. Thorac. Surg., September 1, 2008; 86(3): 849 - 856.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. M. Gillinov
Choice of Surgical Lesion Set: Answers From the Data
Ann. Thorac. Surg., November 1, 2007; 84(5): 1786 - 1792.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al.
HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society.
Europace, June 1, 2007; 9(6): 335 - 379.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. Sagbas, B. Akpinar, I. Sanisoglu, B. Caynak, B. Tamtekin, K. Oral, and B. Onan
Video-Assisted Bilateral Epicardial Pulmonary Vein Isolation for the Treatment of Lone Atrial Fibrillation
Ann. Thorac. Surg., May 1, 2007; 83(5): 1724 - 1730.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. M. Stulak, T. M. Sundt III, J. A. Dearani, R. C. Daly, T. A. Orsulak, and H. V. Schaff
Ten-year Experience With the Cox-Maze Procedure for Atrial Fibrillation: How Do We Define Success?
Ann. Thorac. Surg., April 1, 2007; 83(4): 1319 - 1324.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. M. Gillinov, S. Bhavani, E. H. Blackstone, J. Rajeswaran, L. G. Svensson, J. L. Navia, B.G. Pettersson, J. F. Sabik III, N. G. Smedira, T. Mihaljevic, et al.
Surgery for Permanent Atrial Fibrillation: Impact of Patient Factors and Lesion Set
Ann. Thorac. Surg., August 1, 2006; 82(2): 502 - 514.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. M. Gillinov, D. M. Cosgrove, and P. M. McCarthy
Disclosure of a Financial Relationship Relating to "Surgery for Paroxysmal Atrial Fibrillation in the Setting of Mitral Valve Disease: A Role for Pulmonary Vein Isolation. Ann Thorac Surg 2006;81:19-28."
Ann. Thorac. Surg., March 1, 2006; 81(3): 1177 - 1177.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The Society of Thoracic Surgeons.