Ann Thorac Surg 2007;84:1073-1074
© 2007 The Society of Thoracic Surgeons
Correspondence
Reply
Peter Lukac, MD, PhD,
Vibeke E. Hjortdal, MD, PhD,
Peter S. Hansen, MD, PhD
Department of Cardiology, Skejby University Hospital, Aarhus N, DK-8200 Denmark
(Email: lukacpe2{at}hotmail.com).
To the Editor:
We thank Misawa and colleagues [1] and Garcia-Villarreal [2] for their thoughtful comments on our article [3].
Both letters relate to the transient nature of sinus node dysfunction after the superior transseptal approach. The superior transseptal approach was an independent predictor of pacemaker implantation because of sinus node dysfunction in our study. Nine patients had a pacemaker implanted because of sinus node dysfunction after the superior transseptal approach. We looked at signs of sinus node function recovery in these patients. Two of 9 patients had a relatively late implantation (6 weeks and 2 years after surgery, respectively), and thus the dysfunction was probably a permanent problem. Another 2 patients still had nodal rhythm at their 4-month follow-up. Two patients in whom the indications for pacemaker implantation were sinus pauses had sinus rhythm at their 4-month follow-up; however, due to an intermittent character of the problem in these 2 patients, no conclusion about spontaneous resolution of the problem can be drawn. Similarly, one patient developed chronic atrial fibrillation, and therefore sinus node function could not be evaluated. Two patients with postoperative nodal rhythm had return of sinus rhythm at their 4-month visit. In conclusion, only in the last 2 patients we have certain evidence that the sinus node dysfunction after the superior transseptal approach was a transient phenomenon, but an intermittent sinus node dysfunction can not be ruled out even in these 2 patients.
We do not agree that the PR interval can be used to monitor sinus node function. The PR interval is a measure of atrioventricular conduction and internodal conduction rather than sinus node function.
With regard to the technique of the superior transseptal approach, in the majority of our patients, the incision was made parallel to the superior vena cava, but some had the incision extended onto the superior portion of the left atrium behind the aorta. Unfortunately, we do not have the data on the course of the incision in the individual patients. On the other hand, we believe that the right atrial part and not the left atrial part of the incision is responsible for the genesis of sinus node dysfunction.
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References
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- Misawa Y, Saito T, Konishi H. The need for pacemaker implantation after using a superior transseptal approach: Letter 1 Ann Thorac Surg 2007;84:1072-1073.[Free Full Text]
- Garcia-Villarreal OA. Superior septal approach for mitral valve surgery: Letter 2 Ann Thorac Surg 2007;84:1073.[Free Full Text]
- Lukac P, Hjortdal VE, Pedersen AK, Mortensen PT, Jensen HK, Hansen PS. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach Ann Thorac Surg 2007;83:77-82.[Abstract/Free Full Text]
Related Article
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The Need for Pacemaker Implantation After Using a Superior Transseptal Approach: Letter 1
- Yoshio Misawa, Tsutomu Saito, and Hiroaki Konishi
Ann. Thorac. Surg. 2007 84: 1072-1073.
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