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Ann Thorac Surg 2002;73:1022
© 2002 The Society of Thoracic Surgeons

Correspondence

Simple pulmonary vein isolation for atrial fibrillation

Renato A. K. Kalil, MD, PhDa, Gustavo G. Lima, MDa

a Unidade de Pesquisa, Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel, 395, Santana, CEP: 90.620-001 Ponto Alegre-RS, Brazil

e-mail: kalil{at}cardnet.tche.br

To the Editor

We read with special interest the case report by Sueda and colleagues [1]. We have been performing an essentially similar surgical technique to that described and for the same purposes since 1999. In our experience with this technique, rhythm returns to sinus in a percentage similar to that observed in the maze procedure for the same conditions [2]. Our results were published in early 2000 [3].

As in the maze procedure, the surgical technique consists of a circumferential incision around the four pulmonary veins’ ostia, and a perpendicular incision from this down to the mitral annulus. Additionally, the atrial appendage is resected. No cryolesion or radiofrequency ablation is employed. The incisions are sutured in a continuous fashion using 3-0 polypropilene (Fig 1). Valve lesions are treated appropriately.



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  		Fig 1. Diagram of the operation, showing a circumferential incision around all four pulmonary veins, left atrial appendage resection, and the perpendicular incision down to the mitral annulus.

 
This procedure was performed on 17 patients between July 1999 and July 2001. The results at the time of hospital discharge: 82% (14 patients) had sinus rhythm, 5.8% (1 patient) had junctional rhythm, 5.8% (1 patient) had atrial fibrillation, and 5.8% (1 patient) had atrial flutter. We have 11 patients with more than 12 months follow-up; 91.6% (11 patients) have sinus rhythm, and 4 (33.3%) are on amiodarone. Amiodarone was used in 4 patients during the first 2 postoperative months. One patient (8.3%) received a DDD pacemaker, but now is in sinus rhythm.

We conclude from these results that pulmonary veins play a role, not only in paroxysmal, but also in chronic atrial fibrillation. We suggest that this simple (PVI) procedure, in which sophisticated instrumentation is unnecessary, might be as effective as the maze procedure for chronic atrial fibrillation and contribute to the more widespread surgical treatment of this arrhythmia. Our revised experience with this technique has been sent to The Annals, to be considered for publication.

Doctor Sueda and colleagues are to be complimented for their work in this area.

References

  1. Sueda T., Imai K., Orihashi K., Watari M., Okada K. Pulmonary vein orifice isolation for elimination of chronic atrial fibrillation. Ann Thorac Surg 2001;71:708-710.[Abstract/Free Full Text]
  2. Kalil R.A.K., Albrecht A., Lima G.G., et al. Results of the surgical treatment of chronic atrial fibrillation. Arq Bras Cardiol 1999;73:144-148.
  3. Kalil R.A.K., Lima G.G., Abrahao R., et al. Táecnica cirúrgica simplificada pode ser eficaz no tratamento da fibrilaçcão atrial crônica secundária a lesão valvar mitral?. Rev Bras Cir Cardiovasc 2000;15:129-135.

Related Article

Simple pulmonary vein isolation for atrial fibrillation: Reply
Taijiro Sueda
Ann. Thorac. Surg. 2002 73: 1022-1023. [Extract] [Full Text] [PDF]




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