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Ann Thorac Surg 2000;69:1646-1647
© 2000 The Society of Thoracic Surgeons

Correspondence

Left atrial reduction for chronic atrial fibrillation

Shuji Fukunaga, MDa, Tomokazu Kosuga, MDa, Shigeaki Aoyagi, MDa

a Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan

e-mail: shuji{at}med.kurume-u.ac.jp

To the Editor

We read with great interest the report by Sankar and Farnsworth [1] wherein they describe a surgical ablation of atrial fibrillation (AF) associated with mitral valve disease. Their technique is based on Batista’s [2] autotransplantation, modified to avoid the complexity of autotransplantation by reducing the left atrial (LA) volume and isolating the pulmonary vein. The concept of this technique is based on the following: excluding the common site of atrial reentry around, and atrial ectopic activity at, the orifices of the pulmonary vein, and removing a critical mass of atrial tissue that appears necessary to sustain AF. According to this method, the sufficient LA reduction can be expected even in the LA dilated case, which is the factor that determines whether the maze procedure is effective [3].

Since February 1999, we have experienced five cases of this technique applied to treat AF associated with heart diseases. These cases included 1 man and 4 women, with a mean age of 58 years. The basic heart diseases included mitral valve stenosis in four cases and ruptured aneurysm of sinus Valsalva in one case. All patients were associated with mild tricuspid regurgitation. The AF history of patients ranged from 4 months to 11 years, with an average of 4.7 years. According to two-dimensional echocardiography, the mean preoperative LA dimension was 55 mm. Mitral valve replacement or closure of ruptured aneurysm of sinus Valsalva was performed, then LA reduction was added. The surgical technique of LA reduction was that described by Sankar and Farnsworth [1]. Figure 1 shows the reduced LA wall as a ring. Although a left ventricular rupture occurred in one case intraoperatively, it was successfully repaired by valve re-replacement. No operative death occurred and all patients recovered sinus rhythm immediately after operation. Only 1 patient showed a transient atrial flutter, on the 7th postoperative day, which rapidly disappeared. All patients have maintained sinus rhythm at follow-up 3.6 months (range, 1 to 6 months) after operation. Two-dimensional echocardiography showed that the LA dimension has been reduced to an average of 44 mm, and Doppler echocardiography showed an a-wave through the mitral valve in 4 patients and through the tricuspid valve in all patients.



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  		Fig 1. Reduced left atrial (LA) wall including LA appendage. Arrows indicate the circumference of the pulmonary veins.

 
The early results of LA reduction for AF in LA dilated cases are satisfactory. More specifically, the existence of the postoperative a-wave indicated the technique’s usefulness for a booster effect of the atrium, which seemed to result from the fact that this technique does not involve segmenting the heart atrium as the maze operation does. Although there was a small number of patients and follow-up was short, we believe that this technique is useful for patients because of its capacity to maintain sinus rhythm.

References

  1. Sankar N.M., Farnsworth A.E. Left atrial reduction for chronic atrial fibrillation associated with mitral valve disease. Ann Thorac Surg 1998;66:254-256.[Abstract/Free Full Text]
  2. Batista R.J.V. Retrograde warm blood cardioplegia for difficult cardiac surgical problems (heart autotransplantation). In: Salerno T.A., ed. Warm heart surgery. London: Arnold, 1995:112-118.
  3. Kawaguchi A.T., Kosakai Y., Isobe F., et al. Surgical stratification of patients with atrial fibrillation secondary to organic cardiac lesions. Eur J Cardiothorac Surg 1996;10:983-989.[Abstract]

Related Article

Reply
Alan E. Farnsworth
Ann. Thorac. Surg. 2000 69: 1647. [Extract] [Full Text] [PDF]




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