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Central European Journal of Medicine

, Volume 1, Issue 1, pp 58–68 | Cite as

Radiofrequency pulmonary veins isolation of atrial fibrillation in patients undergoing mitral valve replacement

  • Maciej L. Grabowski
  • Tomasz Hryniewiecki
  • Tomasz Gawałkiewicz
  • Janina Stępińska
  • Andrzej Biederman
Research Article
  • 63 Downloads

Abstract

Introduction: Pulmonary veins isolation (PVI) is useful method in patients (pts) with mitral valve disease (MVD) and chronic atrial fibrillation (AF) during prosthetic valve implantation.

The aim of the study: To evaluate e.ectiveness of PVI in the treatment of AF in pt with MVD during valve implantation.

Material and methods: 45 pts (mean age 55 yrs) with AF were operated on for MVD.RF ablation around the pulmonary veins, a lesion between them and to the mitral annulus were performed. There were 44 prostheses implanted, 1 case of mitral valve annuloplasty, associated with tricuspid valve repair (5 pts), aorto-coronary bypass procedure (2 pts), ASD II closure (1 pt).

Results: SR was achieved in 2 (44,5%) pts, 21 (46,5%)pts were in AF, 4 (9%) pts needed pacing. No correlation between SR restoration and preoperative echocardiographic parameters, age, gender, NYHA functional class were found. In long-term follow-up 1 pt have reversed AF to SR spontaneously. There were 6 cases of paroxysmal AF,1 pt needed pacemaker implantation. 20 (44,5%) pts are in SR, 20 (44,5%) in AF, 5 (11%) in permanent pacing.

Conclusion: PVI with RF use is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease.

Keywords

Mitral valve disease atrial fibrillation pulmonary veins isolation 

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References

  1. [1]
    J. Acar, P.L. Michel, B. Cormier, A. Vahanian and B. Iung: “Features of patients with severe mitral stenosis with respect to atrial rhythm”, Acta Cardiol., Vol. 47, (1992), pp. 115–124.PubMedGoogle Scholar
  2. [2]
    R.A. Kalil, C.B. Maratia, A. D’Avila and F.B. Ludwig: “Predictive factors for persistence of atrial fibrillation after mitralvalve operation”, Ann Thorac. Surg., Vol. 67, (1999), pp. 614–617.PubMedCrossRefGoogle Scholar
  3. [3]
    J.L. Cox, R.B. Schuessler, H.J. D’Agostino: “The surgical treatment of atrail fibrillation III. Development of a definitive surgical procedure”, J. Thorac. Cardiovasc. Surg., Vol. 101, (1991), pp. 569–583.PubMedGoogle Scholar
  4. [4]
    M. Haissaguerre, P. Jais, D.C. Shah et al: “Spontaneous initiation of atrial fibrillation be ectopic beats orginating from the pulmonary veins”, N. Engl. J. Med., Vol. 339, (1998), pp. 659–666.PubMedCrossRefGoogle Scholar
  5. [5]
    J.Q. Melo, J.P. Neves, L.M. Abecasis, P. Adragao, R. Ribeiras and R. Seabra-Gomes: “Operative risks of the maze procedure associated with mitral valve surgery”, Cardiovasc. Surg., Vol. 5, (1997), pp. 112–116.PubMedCrossRefGoogle Scholar
  6. [6]
    J.Q. Melo, J. Neves, P. Adrago et al: “When and how to report of surgery on atrial fibrillation”, Eur. J. Cardiothorac. Surg., Vol. 12, (1997), pp. 739–744.PubMedCrossRefGoogle Scholar
  7. [7]
    U.R. Jessurun, N.M. van Hemel, J.C. Kelder et al: “Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed?”, Eur. J. Cardiothorac. Surg., Vol. 17, (2000), pp. 530–537.PubMedCrossRefGoogle Scholar
  8. [8]
    J.J. Morris Jr, M. Entman, W.C. North, Y. Kong and H. McIntosh: “The changes in cardiac output with reversion of atrial fibrillation to sinus rhythm”, Circulation, Vol. 31, (1965), pp. 670–678PubMedGoogle Scholar
  9. [9]
    S. Geidel, M. Lass, S. Boczor, K.H. Kuck and J. Ostermeyer: “Surgical treatment of atrial fibrillation during heart valve surgery”, Interactive Cardiovascular and Thoracic Surgery, Vol. 2, (2003), pp. 160–165.CrossRefGoogle Scholar
  10. [10]
    M.C. Wijffels, H.J. Kirchhof, R. Dorland and M.A. Allessie: “AF begets AF. A study in awake chronically instrumented goats”, Circulation, Vol. 92, (1995), pp. 1954–1968.PubMedGoogle Scholar
  11. [11]
    M. Nyżznyk: Evaluation of treatment strategies in patients with atrial fibrillation after mitral valve disease correction, Institute of Cardiology, Warsaw, 1999.Google Scholar
  12. [12]
    G.K. Moe: “On the multiple wavelet hypothesis of atrial fibrillation”, Arch. Int. Pharmacodyn. Ther., Vol. 31, (1962), pp. 670–678.Google Scholar
  13. [13]
    M. Allessie, W.J. Lammers, F.I. Bunke and J. Hollen: “Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation”, In: D. Zipes and J. Jalife (Eds.): Cardiac electrophysiology and arrhythmias, Cruno and Straiton, New York, 1985, pp. 265–275.Google Scholar
  14. [14]
    J.L. Cox, R.B. Schuessler, D.G. Lappas and J.P. Boineau: “An 8 1/2 year clinical experience with surgery for atrial fibrillation”, Ann Thorac. Surg., Vol. 224, (1996), pp. 267–275.Google Scholar
  15. [15]
    M.C. Chen, G.B. Gou, J.P. Chang, K.H. Yeh and M. Fu: “Radiofrequency and cryoablation of atral fibrillation in patients undergoing valvular operations”, Ann Thorac. Surg., Vol. 63, (1997), pp. 1070–1075.CrossRefGoogle Scholar
  16. [16]
    H. Nakagawa, W.S. Yamanashi, J.V. Pitha, M. Arruda, X. Wang, K. Ohtomo, K.J. Beckman, J.H. McClelland, R. Lazzara and W.M. Jackman: “Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with saline irrigated electrode versus temperature control in a canine thigh muscle preparation”, Circulat., Vol. 91, (1995), pp. 2264–2273.Google Scholar
  17. [17]
    F. Gregori Jr, C.O. Cordeiro, W.J. Couto, S.S. da Silva, W.K. de Aquino and A.J. Nechar: “Cox maze operation without cryoablation for the treatment of chronic atrial fibrillation”, Ann Thorac. Surg., Vol. 60, (1995), pp. 361–363.PubMedCrossRefGoogle Scholar
  18. [18]
    N. Sandoval, V.M. Velasco, O. Orjuela et al: “Concomitant mitral valve or atrial septal defect surgery and themodified Cox-Maze procedure”, Am. J. Cardiol., Vol. 77, (1996), pp. 591–596.PubMedCrossRefGoogle Scholar
  19. [19]
    D. Keane and J. Ruskin: “Pulmonary vein isolation for atrial fibrillation”, Rev. Cardiovasc. Med., Vol. 3, (2002), pp. 167–175.PubMedGoogle Scholar
  20. [20]
    S.S. Yang, V. Maranhao, R. Monheit et al: “Cardioversion following open heart valvular surgery”, Br. Heart J., Vol. 28, (1966), pp. 309–315.PubMedGoogle Scholar
  21. [21]
    D.R. Kahn, M.M. Krish, P.W. Ferguson and H. Sloan: “Cardioversion after mitral valve operation”, Circulation, Vol. 35, (1967), pp. 182–185.Google Scholar
  22. [22]
    Y.L. Chua, H.V. Schaff, T.A. Orszulak and J.J. Morris: “Outcome of mitral valve repair in patients with preoperative atrial fibrillation”, J. Thorac. Cardiovasc. Surg., Vol. 107, (1994), pp. 408–15.PubMedGoogle Scholar
  23. [23]
    M.Y. Flugelman, Y. Hasin, N. Katznelson, M. Kriwisky, A. Shefer, M.S. Gotsman: “Restoration and maintenance of sinus rhythm after mitral valve surgery for mitral stenosis”, Am. J. Cardiol., Vol. 54, (1984), pp. 617–619.PubMedCrossRefGoogle Scholar
  24. [24]
    H. Tanaka, T. Narisawa, T. Mori, M. Masuda, T. Suzuki and T. Takaba: “Pulmonary vein isolation for chronic atrial fibrillation associated with mitral vlave disease. The midterm results”, Ann Thorac. Cardiovasc. Surg., Vol. 8, (2002), pp. 88–91.PubMedGoogle Scholar
  25. [25]
    T. Sueda, K. Imai, O. Ishii, K. Orihashi, M. Watari and K. Okada: “Effcacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery”, Ann Thorac. Surg., Vol. 71, (2001), pp. 1189–1193.PubMedCrossRefGoogle Scholar
  26. [26]
    N.M. Sankar, K. Suresh, R. Agarwal and K.M. Cherian: “Pulmonary vein isolation and left atrial reduction for chronic atrial fibrillation secondary to mitral valve disease”, Ann Thorac. Surg., Vol. 75, (2003), p. 1680.PubMedCrossRefGoogle Scholar
  27. [27]
    M.R. Williams, J.R. Stewart, S.F. Bolling, S. Freeman, J.T. Anderson, M. Argenziano et al.: “Surgical treatment of atrial fibrillation using radiofrequency energy”, Ann. Thorac. Surg., Vol. 71, (2001), pp. 1939–1943.PubMedCrossRefGoogle Scholar
  28. [28]
    R.A.K. Kalil, G.G. Lima, T.L.L. Leiria et al: “Simple surgical isolation of pulmonary veins for treating secondary atrial fibrillation in mitral valve disease”, Ann Thorac. Surg., Vol. 73, (2002), pp. 1169–1173.PubMedCrossRefGoogle Scholar
  29. [29]
    B. Sonmez, E. Demirsoy, N. Yagaa et al: A fatal complication due to radiofrequency ablation for atrial fibrillation: atrio-esophageal fistula. Ann Thorac Surg Vol 76, (2003), pp.281–283.PubMedCrossRefGoogle Scholar
  30. [30]
    AA.C. Skanes, R. Yee, A.D. Krahn and G.J. Klein: “Cryoablation of atrial arrythmias”, Card. Electrophysiol. Rev., Vol. 6, (2002), pp. 383–388.PubMedCrossRefGoogle Scholar

Copyright information

© Central European Science Journals Warsaw and Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • Maciej L. Grabowski
    • 1
  • Tomasz Hryniewiecki
    • 1
  • Tomasz Gawałkiewicz
    • 2
  • Janina Stępińska
    • 1
  • Andrzej Biederman
    • 2
  1. 1.Department of Acquired Valvular Heart DiseaseInstitute of CardiologyWarsawPoland
  2. 2.1st Department of Cardiac SurgeryInstitute of CardiologyWarsawPoland

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