Skip to main content
Log in

Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Late recovery of sinus rhythm is unusual in patients with permanent AF treated by (radiofrequency) RF maze procedure during mitral valve surgery. Identification of clinical and instrumental preoperative factors predictive of early success of RF ablation in patients with permanent AF undergoing mitral valve surgery may improve selection of subjects to obtain long-term results. Hundred and thirty consecutive patients with permanent AF and mitral valve disease underwent modified RF maze procedure during concomitant mitral valve surgery. Rheumatic valve disease (61 pts) and mitral valve prolapse (41 pts) were the more common aetiology of valve abnormalities. Mitral valve replacement was performed in 54 % of patients and mitral valve repair in the remaining 46 %. Four patients died after surgery. At discharge, 87 patients (69 %) were in sinus rhythm (group 1) and 43 patients in AF persisted (group 2). At an average 24-month follow-up, sinus rhythm was present in 67 % of patients, and 33 % were in atrial fibrillation. In this period, late recovery of sinus rhythm was observed only in five patients, while eight discharged in sinus rhythm developed again atrial fibrillation. Among preoperative parameters at univariate analysis female sex, atrial fibrillation >24 months, left atrial diameter >54 mm, left atrial area >24 cm2, rheumatic valve disease and NYHA class were associated with persistence of AF. At Cox regression multivariate analysis, increased left atrial area (OR 1.07 per unit increase—95 % CI 1.01–1.131) and rheumatic aetiology of valve disease (OR 4.52, 95 % CI 1.65–12.4) were associated with persistence of AF at hospital discharge. Persistence of AF after RF ablation in patients undergoing mitral valve surgery is related to aetiology, e.g. rheumatic valve disease, and to increasing left atrial diameter. Due to low rate of late recovery of sinus rhythm, indication to RF ablation associated with MV surgery should be carefully considered in patients with large atria and rheumatic mitral valve disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kernis SJ, Nkomo VT, Messika-Zeitoun D, Gersh BJ, Sundt TM 3rd, Ballman KV, Scott CG, Schaff HV, Enriquez-Sarano M (2004) Atrial fibrillation after surgical correction of mitral regurgitation in sinus rhythm: incidence, outcome, and determinants. Circulation 110:2320 –2325

    Article  PubMed  Google Scholar 

  2. Obadia JF, el Farra M, Bastien OH, Lièvre M, Martelloni Y, Chassignolle JF (1997) Outcome of atrial fibrillation after mitral valve repair. J Thorac Cardiovasc Surg 114(2):179-185

    Article  CAS  PubMed  Google Scholar 

  3. Lim E, Barlow CW, Hosseinpour AR, Wisbey C, Wilson K, Pidgeon W, Charman S, Barlow JB, Wells FC (2001) Influence of atrial fibrillation on outcome following mitral valve repair. Circulation 104(12 Suppl 1):I59

    CAS  PubMed  Google Scholar 

  4. Raanani E, Albage A, David TE, Yau TM, Armstrong S (2001) The efficacy of the Cox/maze procedure combined with mitral valve surgery: a matched control study. Eur J Cardiothorac Surg 19:438-442

    Article  CAS  PubMed  Google Scholar 

  5. Khargi K, Hutten BA, Lemke B, Deneke T (2005) Surgical treatment of atrial fibrillation: a systemic review. Eur J Cardiothorac Surg 27:258-265

    Article  PubMed  Google Scholar 

  6. Reston JT, Shuhaiber JH (2005) Meta-analysis of clinical outcomes of maze-related surgicalprocedures for medically refractory atrial fibrillation. Eur J Cardiothor Surg 28: 724-730

    Article  Google Scholar 

  7. Sie HT, Beukema, WP, Misier, AR, Elvan A, Ennema JJ, Haalebos MM, Wellens HJ (2001) Radiofrequency modified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery. J Thorac Cardiovasc Surg 122:249-256

    Article  CAS  PubMed  Google Scholar 

  8. Wong JJW, Mak KH (2006) Impact of Maze and Concomitant Mitral Valve Surgery on Clinical Outcomes. Ann Thorac Surg 82:1938-1947

    Article  PubMed  Google Scholar 

  9. Benussi S (2004) Treatment of atrial fibrillation. Eur J Cardiothorac Surg 26 (suppl 1):S39- S41

    PubMed  Google Scholar 

  10. Fukuda Y, Yoshida T, Inage T, Takeuchi T, Gondo T, Takii E, Imaizumi T (2012) Long-term results of the maze procedure on left ventricular function for persistentatrial fibrillation associated with mitral valve disease. Heart Vessels 27(1):53-57

    Article  PubMed  Google Scholar 

  11. Kosakai Y (2000) Treatment of atrial fibrillation using the maze procedure: the Japanese experience. Semin Thorac Cardiovasc Surg 12:44-52

    Article  CAS  PubMed  Google Scholar 

  12. Shin SH, Park MY, Oh WJ, Hong SJ, Pak HN, Song WH, Lim DS, Kim YH, Shim WJ (2008) Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. J Am Soc Echocardiogr 21(6):697-702

    Article  PubMed  Google Scholar 

  13. Budera P, Straka Z, Osmančík P,, Vaněk T, Jelínek Š, Hlavička J, Fojt R, Červinka P, Hulman M, Šmíd M, Malý M, Widimský P (2012) Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study Eur Heart J 33(21): 2644–2652

    Article  PubMed  PubMed Central  Google Scholar 

  14. Williams MR, Stewart JR, Bolling SF, Freeman S, Anderson JT, Argenziano M, Smith CR, Oz MC (2001) Surgical treatment of atrial fibrillation using radiofrequency energy. Ann Thorac Surg 71: 1939-1944

    Article  CAS  PubMed  Google Scholar 

  15. Chen MC, Chang JP, Chang HW, Chen CJ, Yang CH, Chen YH, Fu M (2005) Clinical determinants of sinus conversion by radiofrequency maze procedure for persistent atrial fibrillation in patients undergoing concomitant mitral valvular surgery. Am J Cardiol 96:1553-1557

    Article  PubMed  Google Scholar 

  16. Mataraci I, Polat A, Mert B, Aydin C, Kirali K (2010) Radiofrequency ablation for atrial fibrillation in rheumatic valvular disease. Heart Lung Circ 9(1):43-49

    Article  Google Scholar 

  17. Yoshihara F, Nishikimi T, Sasako Y, Hino J, Kobayashi J, Minatoya K, Bando K, Kosakai Y, Horio T, Suga S, Kawano Y, Matsuoka H, Yutani C, Matsuo H, Kitamura S, Ohe T, Kangawa K (2002) Plasma atrial natriuretic peptide concentration inversely correlates with left atrial collagen volume fraction in patients with atrial fibrillation: plasma ANP as a possible biochemical marker to predict the outcome of the maze procedure. J Am Coll Cardiol 39(2):288-294

    Article  CAS  PubMed  Google Scholar 

  18. Kataoka T, Hamasaki S, Inoue K, Yuasa T, Tomita K, Ishida S, Ogawa M, Saihara K, Koriyama C, Nobuyoshi M, Sakata R, Tei C (2010) Left atrium volume index and pathological features of left atrial appendage as a predictor of failure in postoperative sinus conversion. J Cardiol 55 (2):274-282

    Article  PubMed  Google Scholar 

  19. Jiang Z, Yin H, He Y, Ma N, Tang M, Liu H, Ding F, Mei J. (2014) Efficacy and safety of novel epicardial circumferential left atrial ablation ewith pulmonary vein isolation in sustained atrial fibrillation. Heart Vessels. doi: 10.1007/s00380-014-0594-4

    Google Scholar 

  20. Sternik L, Luria D, Glikson M, Malachy A, First M, Raanani E (2010) Efficacy of surgical ablation of atrial fibrillation in patients with rheumatic heart disease. Ann Thorac Surg 89 (5):1437-1442

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlo Rostagno.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rostagno, C., Gelsomino, S., Capecchi, I. et al. Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery. Heart Vessels 31, 593–598 (2016). https://doi.org/10.1007/s00380-015-0647-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-015-0647-3

Keywords

Navigation