PMID- 25612746
OWN - NLM
STAT- MEDLINE
DCOM- 20160728
LR  - 20151017
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 48
IP  - 5
DP  - 2015 Nov
TI  - Dilated left atrium as a predictor of late outcome after pulmonary vein isolation 
      concomitant with aortic valve replacement and/or coronary artery bypass 
      graftingdagger.
PG  - 765-77; discussion 777
LID - 10.1093/ejcts/ezu532 [doi]
AB  - OBJECTIVES: Left atrial (LA) dimension can predict atrial fibrillation (AF) 
      recurrence after catheter-based or surgical ablation. Pulmonary vein isolation 
      (PVI) may be a surgical option during aortic valve replacement (AVR) and/or 
      coronary artery bypass grafting (CABG), though consensus regarding patient 
      selection and late outcome is lacking. METHODS: We studied 160 patients (mean age 
      70 +/- 9 years) with paroxysmal AF who underwent radiofrequency-based PVI during 
      AVR and/or CABG, and were followed up postoperatively for at least 6 months. Mean 
      preoperative LA dimension was 44 +/- 7 mm. Serial echocardiography was performed to 
      evaluate left ventricular (LV) and LA dimensions, E/e', estimated systolic 
      pulmonary artery (PA) pressure and degree of valvular regurgitation. Follow-up 
      was completed with a mean duration of 47 +/- 25 months. RESULTS: At the latest 
      follow-up, 133 patients (83%) remained in sinus rhythm. Preoperative LA dimension 
      was independently associated with increased risk of AF recurrence at 6 months 
      after surgery [adjusted odds ratio 1.3 per 1-mm increase in LA dimension, 95% 
      confidence interval (CI) 1.1-1.6, P < 0.001]. Receiver-operating characteristic 
      curve analysis demonstrated an optimal cut-off value for preoperative LA 
      dimension of 45 mm to predict sinus rhythm restoration (98% for <45 mm vs 55% for 
      >/=45 mm, P < 0.001). Patients with LA dimension >/=45 mm had a significantly lower 
      5-year survival rate (62 +/- 7 vs 82 +/- 7%, P = 0.025) and freedom from adverse 
      events defined as cerebral infarction/haemorrhage, admission for heart failure, 
      catheter ablation and permanent pacemaker implantation (58 +/- 7 vs 91 +/- 4%, P < 
      0.001). Multivariate analysis showed that preoperative LA dimension >/=45 mm was 
      independently associated with adverse events (adjusted hazards ratio 2.4, 95% CI 
      1.2-5.1, P = 0.019). Serial echocardiography demonstrated improvement in LV 
      systolic function irrespective of LA dimension, whereas patients with LA 
      dimension >/=45 mm showed less improvement in LA dimension and systolic PA pressure 
      (interaction effect P < 0.001) and persistent higher E/e' (group effect P < 
      0.001), along with aggravated tricuspid regurgitation. CONCLUSIONS: In patients 
      with paroxysmal AF related to aortic valve disease and/or coronary artery 
      disease, a dilated left atrium (>/=45 mm) was associated with inferior AF- and 
      event-free survival after PVI, accompanied by persistent abnormalities in cardiac 
      and haemodynamic function. These findings may assist patient selection for PVI 
      during AVR and/or CABG.
CI  - (c) The Author 2015. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Kainuma, Satoshi
AU  - Kainuma S
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan Department of Cardiovascular Surgery, Japan Labor Health 
      and Welfare Organization Osaka Rosai Hospital, Sakai, Japan.
FAU - Mitsuno, Masataka
AU  - Mitsuno M
AD  - Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, 
      Japan.
FAU - Toda, Koichi
AU  - Toda K
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Funatsu, Toshihiro
AU  - Funatsu T
AD  - Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization 
      Osaka Rosai Hospital, Sakai, Japan.
FAU - Nakamura, Teruya
AU  - Nakamura T
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Miyagawa, Shigeru
AU  - Miyagawa S
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Yoshikawa, Yasushi
AU  - Yoshikawa Y
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Fukushima, Satsuki
AU  - Fukushima S
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Yoshioka, Daisuke
AU  - Yoshioka D
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Saito, Tetsuya
AU  - Saito T
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Nishi, Hiroyuki
AU  - Nishi H
AD  - Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan.
FAU - Takahashi, Toshiki
AU  - Takahashi T
AD  - Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan.
FAU - Sakaki, Masayuki
AU  - Sakaki M
AD  - Department of Cardiovascular Surgery, Osaka National Hospital, Osaka, Japan.
FAU - Monta, Osamu
AU  - Monta O
AD  - Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
FAU - Matsue, Hajime
AU  - Matsue H
AD  - Department of Cardiovascular Surgery, Rinku General Medical Center, Izumisano, 
      Japan.
FAU - Masai, Takafumi
AU  - Masai T
AD  - Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, 
      Japan.
FAU - Sakaguchi, Taichi
AU  - Sakaguchi T
AD  - Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, 
      Okayama, Japan.
FAU - Yoshitaka, Hidenori
AU  - Yoshitaka H
AD  - Department of Cardiovascular Surgery, Sakakibara Heart Institute of Okayama, 
      Okayama, Japan.
FAU - Ueno, Takayoshi
AU  - Ueno T
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Kuratani, Toru
AU  - Kuratani T
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Daimon, Takashi
AU  - Daimon T
AD  - Departments of Biostatistics, Hyogo College of Medicine, Nishinomiya, Japan.
FAU - Taniguchi, Kazuhiro
AU  - Taniguchi K
AD  - Department of Cardiovascular Surgery, Japan Labor Health and Welfare Organization 
      Osaka Rosai Hospital, Sakai, Japan.
FAU - Miyamoto, Yuji
AU  - Miyamoto Y
AD  - Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, 
      Japan.
FAU - Sawa, Yoshiki
AU  - Sawa Y
AD  - Department of Cardiovascular Surgery, Osaka University Graduate School of 
      Medicine, Suita, Japan yshksw2@gmail.com.
CN  - Osaka Cardiovascular Surgery Research (OSCAR) Group
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150121
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/*etiology
MH  - Coronary Artery Bypass/*adverse effects
MH  - Female
MH  - Heart Atria/*physiopathology
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Veins/surgery
MH  - ROC Curve
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Left atrial remodelling
OT  - Non-mitral valve disease
OT  - Paroxysmal atrial fibrillation
OT  - Pulmonary vein isolation
FIR - Egami, Yasuyuki
IR  - Egami Y
FIR - Yoshida, Shohei
IR  - Yoshida S
FIR - Goto, Takasumi
IR  - Goto T
FIR - Samura, Takaaki
IR  - Samura T
FIR - Yamada, Mitsutomo
IR  - Yamada M
FIR - Miyake, Keisuke
IR  - Miyake K
FIR - Masada, Kenta
IR  - Masada K
FIR - Tanioka, Hideki
IR  - Tanioka H
FIR - Nakamura, Yuki
IR  - Nakamura Y
FIR - Suzuki, Kota
IR  - Suzuki K
FIR - Yamashita, Mariko
IR  - Yamashita M
FIR - Matsuo, Chikako
IR  - Matsuo C
FIR - Fujioka, Misa
IR  - Fujioka M
EDAT- 2015/01/24 06:00
MHDA- 2016/07/29 06:00
CRDT- 2015/01/24 06:00
PHST- 2014/10/04 00:00 [received]
PHST- 2014/12/10 00:00 [accepted]
PHST- 2015/01/24 06:00 [entrez]
PHST- 2015/01/24 06:00 [pubmed]
PHST- 2016/07/29 06:00 [medline]
AID - ezu532 [pii]
AID - 10.1093/ejcts/ezu532 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2015 Nov;48(5):765-77; discussion 777. doi: 
      10.1093/ejcts/ezu532. Epub 2015 Jan 21.