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Atrial fibrillation surgery in nonrheumatic mitral valve disease

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Abstract

Atrial fibrillation (AF) is present in 30–50% of patients presenting for mitral valve surgery. If left untreated, AF in these patients is associated with increased morbidity and, possibly, increased mortality. Therefore, concomitant management of the arrhythmia is indicated in most mitral valve patients with preexisting AF. The cut-and-sew Cox-Maze III procedure is extremely effective, eliminating AF in 80–95%; however, it has been supplanted by newer operations that rely upon alternate energy sources to create lines of conduction block. Early and midterm results are good with a variety of technologies. Choice of lesion set remains a matter of debate, but success of ablation appears to be enhanced by a biatrial lesion set and exceeds 90% in some series. Targeted areas for improvement in combined mitral valve surgery and AF ablation include acceptance of uniform standards for reporting results, development of improved technology for ablation and intraoperative assessment, and creation of instrumentation that facilitates minimally invasive approaches.

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Acknowledgments

This work is supported by the Atrial Fibrillation Innovation Center, a Third Frontier project funded by the State of Ohio.

Disclosures

Dr. Gillinov is a consultant to Edwards Lifesciences, LLC and to Medtronic, Inc. He is a former consultant to AtriCure, Inc. He has received honoraria for speaking from Medtronic, Inc., St. Jude Medical, Inc., and Boston Scientific. He receives research support from the Atrial Fibrillation Innovation Center, a Third Frontier project funded by the State of Ohio. The Cleveland Clinic has an indirect equity interest in AtriCure, Inc.

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  1. The Center for Atrial Fibrillation Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F24, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Marc Gillinov

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Correspondence to Marc Gillinov.

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Supported by the Atrial Fibrillation Innovation Center, a Third Frontier Project funded by the State of Ohio.

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Gillinov, M. Atrial fibrillation surgery in nonrheumatic mitral valve disease. J Interv Card Electrophysiol 20, 101–107 (2007). https://doi.org/10.1007/s10840-007-9171-4

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