PMID- 18154775
OWN - NLM
STAT- MEDLINE
DCOM- 20080125
LR  - 20220330
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 85
IP  - 1
DP  - 2008 Jan
TI  - Right isthmus ablation reduces supraventricular arrhythmias after surgery for 
      chronic atrial fibrillation.
PG  - 39-48
AB  - BACKGROUND: Clinical, electrocardiographic, and echocardiographic results of 
      atrial fibrillation (AF) ablation by left mini-Maze, with or without concomitant 
      cavotricuspid isthmus ablation, during cardiac surgery were analyzed. METHODS: 
      Eighty-seven patients undergoing radiofrequency left mini-Maze without (group A) 
      or with (group B) concomitant cavotricuspid isthmus ablation underwent serial 
      electrocardiography and echocardiography to assess sinus rhythm recovery and 
      atrioventricular remodelling. Recurrence of AF, incidence of atrial flutter, 
      hospital readmission, and episodes of congestive heart failure were recorded. 
      Predictors of AF recurrence were evaluated. RESULTS: Follow-up of 33.4 +/- 11.2 
      months demonstrated 88.5% had sinus rhythm recovery, with normalized E/A velocity 
      in 90.9%. Freedom from AF recurrence, congestive heart failure, and hospital 
      readmission was 72.6% +/- 7.8%, 93.3% +/- 5.5%, and 79.9% +/- 8.2%, respectively, 
      without differences between the two groups. Atrial flutter developed in group A 
      more frequently during hospitalization (19.5% versus 2.2%; p = 0.009) and 
      follow-up (12.2% versus 0%; p = 0.02); freedom from atrial flutter was thus lower 
      (79.6% +/- 7.8% versus 100%; p = 0.024). Although no differences were recorded in 
      postoperative and follow-up New York Heart Association (NYHA) functional class or 
      in postoperative or follow-up echocardiographic indicators between the two 
      groups, AF patients displayed a worse NYHA than did sinus rhythm patients 
      (discharge p = 0.009; follow-up p = 0.0002). Accordingly, only sinus rhythm 
      patients showed reverse remodelling of longitudinal (discharge p = 0.002; 
      follow-up p = 0.0001) and transverse diameter (discharge p = 0.0001; follow-up p 
      = 0.001), and of follow-up left ventricular diastolic diameter (p = 0.0001). 
      Mitral valve disease and high postoperative and follow-up echocardiographic 
      pulmonary pressures were independent predictors of AF recurrence. Left + right 
      ablation was the only protective factor against AF recurrence. CONCLUSIONS: 
      Concomitant cavotricuspid isthmus ablation should be routinely considered in AF 
      surgery, given the shorter hospitalization, low incidence of atrial flutter 
      onset, and beneficial effect on AF recurrences.
FAU - Onorati, Francesco
AU  - Onorati F
AD  - Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Napoli, Italy. 
      frankono@libero.it
FAU - Esposito, Antonio
AU  - Esposito A
FAU - Messina, Gaetana
AU  - Messina G
FAU - di Virgilio, Antonio
AU  - di Virgilio A
FAU - Renzulli, Attilio
AU  - Renzulli A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2008 Jan;85(1):48-9. PMID: 18154776
MH  - Atrial Fibrillation/diagnosis/mortality/*surgery
MH  - Catheter Ablation/*adverse effects/methods
MH  - Chronic Disease
MH  - Confidence Intervals
MH  - Echocardiography, Doppler
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Probability
MH  - Prospective Studies
MH  - Risk Factors
MH  - Statistics, Nonparametric
MH  - Survival Rate
MH  - Tachycardia, Supraventricular/etiology/mortality/*prevention & control
MH  - Treatment Outcome
MH  - Tricuspid Valve/*surgery
MH  - Vena Cava, Superior/surgery
EDAT- 2007/12/25 09:00
MHDA- 2008/01/26 09:00
CRDT- 2007/12/25 09:00
PHST- 2007/04/26 00:00 [received]
PHST- 2007/07/18 00:00 [revised]
PHST- 2007/07/19 00:00 [accepted]
PHST- 2007/12/25 09:00 [pubmed]
PHST- 2008/01/26 09:00 [medline]
PHST- 2007/12/25 09:00 [entrez]
AID - S0003-4975(07)01586-X [pii]
AID - 10.1016/j.athoracsur.2007.07.056 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2008 Jan;85(1):39-48. doi: 10.1016/j.athoracsur.2007.07.056.