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Mid-term results of the box pulmonary vein isolation and the cryo-maze procedure for chronic atrial fibrillation associated with mitral valve disease

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Abstract

Purpose

We performed box pulmonary vein isolation and the modified Maze procedure using cryoablation (cryo-maze) to eliminate chronic atrial fibrillation (AF) associated with mitral valve disease from 1999 to 2004. This article compares the elimination rate of chronic AF and the postoperative occurrence of new atrial tachycardia after both procedures over a follow-up period of >5 years.

Methods

A total of 75 patients were enrolled in the study. Among them, 40 patients underwent box pulmonary vein isolation for chronic AF concomitant with solitary mitral valve surgery. Another 35 patients underwent the cryo-maze procedure for chronic AF concomitantly with both mitral and tricuspid valve surgeries. We evaluated the postoperative AF elimination rate and the occurrence of atrial tachycardia.

Results

During a total of 622.5 patient-years of followup, AF disappeared in 26 of 40 (65%) patients after the box pulmonary vein isolation and in 26 of 35 (74%) patients after the cryo-maze procedure at 5 years. Common atrial flutter occurred in 2 of 40 (5.0%) patients after the pulmonary vein isolation procedure. Left atrial Received: 8 December 2010 / Accepted: 20 April 2011 © The Japanese Association for Thoracic Surgery 2012 tachycardia occurred in 1 (2.9%) and right atrial tachycardia in 1 (2.9%) of 35 patients after the cryo-maze procedure.

Conclusion

The cryo-maze procedure was rather effective for eliminating chronic AF associated with both mitral and tricuspid valve disease, but there were a few cases with new atrial tachycardia. The box pulmonary vein isolation was useful in solitary mitral valve cases.

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References

  1. National Heart, Lung, and Blood Institute Working Group on Atrial Fibrillation. Atrial fibrillation: current understandings and research imperatives. J Am Coll Cardiol 1993;22: 1830–1834.

    Article  Google Scholar 

  2. Cox JL, Schuessler RB, D’Agostino HJ, Stone CM, Chang BC, Cain ME, et al. The surgical treatment of atrial fibrilla tion. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991;101:569–583.

    PubMed  CAS  Google Scholar 

  3. Cox JL, Jaquiss RDB, Schuessler RB, Boineau JP. Modification of the Maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the Maze III procedure. J Thorac Cardiovasc Surg 1995;110:485–495.

    Article  PubMed  CAS  Google Scholar 

  4. Kosakai Y, Kawaguchi AT, Isobe F, Sasako Y, Kilo Y, Kawashima Y. Cox Maze procedure for chronic atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg 1994;108:1049–1055.

    PubMed  CAS  Google Scholar 

  5. Sueda T, Nagata H, Shikata H, Orihahsi K, Morita S, Sueshiro M, et al. Simple left atrial procedure for chronic atrial fibrillation associated with mitral valve disease. Ann Thorac Surg 1996;62:1796–1800.

    Article  PubMed  CAS  Google Scholar 

  6. Sueda T, Nagata H, Orihashi K, Morita S, Okada K, Sueshiro M, et al. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve disease. Ann Thorac Surg 1997;63:1070–1075.

    Article  PubMed  CAS  Google Scholar 

  7. Haissaguerre M, Jais S, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659–666.

    Article  PubMed  CAS  Google Scholar 

  8. Sueda T, Imai K, Ishii O, Orihashi K, Watari M, Okada K. Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery. Ann Thorac Surg 2001;71:1189–1193.

    Article  PubMed  CAS  Google Scholar 

  9. Sueda T, Imai K, Orihashi K, Okada K, Ban K, Hamamoto M. Midterm results of pulmonary vein isolation for the elimination of chronic atrial fibrillation. Ann Thorac Surg 2005;79:521–525.

    Article  PubMed  Google Scholar 

  10. Voeller RK, Baily MS, Zeier A, Lall SC, Sakamoto S, Aubuchon K, et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg 2008;135:870–877.

    Article  PubMed  Google Scholar 

  11. Mokadam NA, McCarthy PM, Gillinov AM, Ryan WH, Moon MR, Mack MJ, et al. A prospective multicenter trial of bipolar radiofrequency ablation for atrial fibrillation: early results. Ann Thorac Surg 2004;78:1665–1670.

    Article  PubMed  Google Scholar 

  12. Imai K, Sueda T, Orihashi K, Watari M, Matsuura Y. Clinical analysis of results of a simple left atrial procedure for chronic atrial fibrillation. Ann Thorac Surg 2001;71:577–581.

    Article  PubMed  CAS  Google Scholar 

  13. Isobe F, Kawashima Y. The outcome and indication of the Cox Maze III procedure for chronic atrial fibrillation with mitral valve disease. J Thorac Cardiovasc Surg 1998;116:220–227.

    Article  PubMed  CAS  Google Scholar 

  14. Gillinov AM, McCarthy PM, Blekestone EH, Rajeswaran J, Pettersson G, Sabik JF, et al. Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. J Thorac Cardiovasc Surg 2005;129:1322–1329.

    Article  PubMed  Google Scholar 

  15. Van Hemmel NM, Defauw JJ, Guiraudon GM, Kelder JC, Jessurun ER, Ernst JM. Long-term follow-up of corridor operation for lone atrial fibrillation: evidence for progression of disease. J Cardiovasc Elctrophysiol 1997;8:967–973.

    Article  Google Scholar 

  16. Bharati D, Lev M. Histology of the normal and diseased atrium. In: Falk RH, Podrid PJ, editors. Atrial fibrillation: mechanism and management. New York: Raven Press; 1992. p. 15–39.

    Google Scholar 

  17. Papone C, Manquso F, Vicedomini G, Gugliotta F, Santinelli G, Ferro A, et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein isolation with a modified approach. Circulation 2004;110:3036–3042.

    Article  Google Scholar 

  18. Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation 2003;107:3176–3183.

    Article  PubMed  Google Scholar 

  19. Sakamoto S, Voeller RK, Melby SJ, Lall SC, Chang NL, Shuessler RB, et al. Surgical ablation for atrial fibrillation: the efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart. J Thorac Cardiovasc Surg 2008;136:1295–1301.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Taiichi Takasaki, Taijiro Sueda, Katsuhiko Imai, Kazumasa Orihashi, Shinya Takahashi, Tatsuya Kurosaki, Satoru Morita & Naomichi Uchida

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  1. Taiichi Takasaki
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  2. Taijiro Sueda
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  3. Katsuhiko Imai
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  4. Kazumasa Orihashi
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  5. Shinya Takahashi
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  6. Tatsuya Kurosaki
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  7. Satoru Morita
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  8. Naomichi Uchida
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Correspondence to Taijiro Sueda.

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Takasaki, T., Sueda, T., Imai, K. et al. Mid-term results of the box pulmonary vein isolation and the cryo-maze procedure for chronic atrial fibrillation associated with mitral valve disease. Gen Thorac Cardiovasc Surg 60, 82–89 (2012). https://doi.org/10.1007/s11748-011-0827-8

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  • DOI: https://doi.org/10.1007/s11748-011-0827-8

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