open access

Vol 66, No 9 (2008)
Other
Published online: 2008-09-30
Submitted: 2012-12-28
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Original article
Efficacy of intra-operative radiofrequency ablation in patients with permanent atrial fibrillation undergoing concomitant mitral valve replacement

Tomasz Myrdko, Maria Śnieżek-Maciejewska, Paweł Rudziński, Jacek Myć, Jacek Lelakowski, Jacek Majewski
Kardiol Pol 2008;66(9):932-938.

open access

Vol 66, No 9 (2008)
Other
Published online: 2008-09-30
Submitted: 2012-12-28

Abstract


Background: Permanent atrial fibrillation (AF) is present before operation and persists after surgery in 30-40% of patients undergoing mitral valve surgery. Using the maze procedure, 75-82% of patients can be cured of AF, but the procedure is difficult and long lasting. Percutaneous radiofrequency (RF) ablation has emerged as an effective therapy for AF in recent years.
Aim: To assess the efficacy of intra-operative RF ablation of AF in patients undergoing mitral valve surgery.
Methods: 100 adults with permanent AF underwent mitral valve replacement. Patients were divided into two groups: the RF group – 50 patients qualified for mitral valve replacement and RF ablation; and the control group – 50 patients selected for mitral valve replacement without ablation. Odds ratio and 95% confidence interval were examined to assess the influence of several factors on the outcome (free from AF during one-year follow-up based on symptoms and serial Holter ECG recordings).
Results: Baseline clinical, demographic and echocardiographic characteristics were similar in both groups. Electrical cardioversion following surgery was required in 76% of patients from the RF group compared with 94% from the control group (p <0.002). In those who underwent cardioversion, sinus rhythm was restored more frequently in RF than control patients (32 vs. 16%, p <0.002). Sinus rhythm at hospital discharge was present in 56% of RF patients compared with 22% of controls (p=0.0001), and after one-year follow-up in 54 vs. 16% (p <0.001), respectively. The use of amiodarone was significantly lower in RF patients compared with controls (32 vs. 70%, p <0.05). NYHA class III (OR 8.5, CI 1.0-394) or IV (OR 36, CI 1.2-1958) and left atrial diameter >6 cm (OR 9.3, CI 0.5-5230) were identified as predictors of AF.
Conclusions: 6 cm are negative prognostic factors for sinus rhythm maintenance.

Abstract


Background: Permanent atrial fibrillation (AF) is present before operation and persists after surgery in 30-40% of patients undergoing mitral valve surgery. Using the maze procedure, 75-82% of patients can be cured of AF, but the procedure is difficult and long lasting. Percutaneous radiofrequency (RF) ablation has emerged as an effective therapy for AF in recent years.
Aim: To assess the efficacy of intra-operative RF ablation of AF in patients undergoing mitral valve surgery.
Methods: 100 adults with permanent AF underwent mitral valve replacement. Patients were divided into two groups: the RF group &#8211; 50 patients qualified for mitral valve replacement and RF ablation; and the control group &#8211; 50 patients selected for mitral valve replacement without ablation. Odds ratio and 95% confidence interval were examined to assess the influence of several factors on the outcome (free from AF during one-year follow-up based on symptoms and serial Holter ECG recordings).
Results: Baseline clinical, demographic and echocardiographic characteristics were similar in both groups. Electrical cardioversion following surgery was required in 76% of patients from the RF group compared with 94% from the control group (p <0.002). In those who underwent cardioversion, sinus rhythm was restored more frequently in RF than control patients (32 vs. 16%, p <0.002). Sinus rhythm at hospital discharge was present in 56% of RF patients compared with 22% of controls (p=0.0001), and after one-year follow-up in 54 vs. 16% (p <0.001), respectively. The use of amiodarone was significantly lower in RF patients compared with controls (32 vs. 70%, p <0.05). NYHA class III (OR 8.5, CI 1.0-394) or IV (OR 36, CI 1.2-1958) and left atrial diameter >6 cm (OR 9.3, CI 0.5-5230) were identified as predictors of AF.
Conclusions: 6 cm are negative prognostic factors for sinus rhythm maintenance.
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Keywords

permanent atrial fibrillation; mitral valve replacement; radiofrequency ablation

About this article
Title

Original article
Efficacy of intra-operative radiofrequency ablation in patients with permanent atrial fibrillation undergoing concomitant mitral valve replacement

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 66, No 9 (2008)

Pages

932-938

Published online

2008-09-30

Bibliographic record

Kardiol Pol 2008;66(9):932-938.

Keywords

permanent atrial fibrillation
mitral valve replacement
radiofrequency ablation

Authors

Tomasz Myrdko
Maria Śnieżek-Maciejewska
Paweł Rudziński
Jacek Myć
Jacek Lelakowski
Jacek Majewski

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