Left Atrial Ablation Versus Biatrial Ablation in the Surgical Treatment of Atrial Fibrillation

摘要

PatientsSurgical TechniquesEchocardiography and Rhythm Follow-UpPostoperative ManagementStatisticsResultsBaseline Patient ProfilesEarly OutcomesRhythm OutcomesLate Clinical OutcomesCommentStudy LimitationsDiscussionReferencesThe purpose of this study was to compare the clinical and rhythm outcomes between left atrial ablation and biatrial ablation in patients with atrial fibrillation-associated mitral valve diseases.MethodsData were collected on 284 patients who underwent left atrial ablation (n = 85) or biatrial ablation (n = 199) of atrial fibrillation using a cryoablation system combined with mitral operation from 2006 through 2009. Outcomes were compared using a propensity score study design based on 20 baseline patient characteristics.ResultsIn baseline characteristics, patients in the biatrial group were more likely to have higher risk clinical and echocardiographic profiles than patients in the left atrial group. There were 2 early deaths (0.7%), 1 in each group, and 5 cases of permanent pacemaker implantation (1.8%) only in the biatrial group. Follow-up was complete in 95.1% (n = 270). During a mean follow-up duration of 26.0 ± 13.3 months, there were 12 late deaths (1 in the left atrial group, 11 in the biatrial group). Cumulative incidence of atrial fibrillation in the absence of antiarrhythmic medications at 2 years was 25.9% ± 5.8% in the left atrial group and 14.3% ± 2.8% in the biatrial group (adjusted hazard ratio 3.06, 95% confidence interval: 1.41 to 6.66, p = 0.005). Major adverse events included stroke in 1, cardiac reoperation in 3, and anticoagulation-related hemorrhages in 16, infective endocarditis in 1, and mechanical valve thrombosis in 1, with no significant intergroup differences in major event-free survival rate (p = 0.73).ConclusionsCompared with left atrial ablation, biatrial ablation was more effective in restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.CTSNet classification:24As the Maze procedure is recognized as the most effective way to eliminate atrial fibrillation (AF), combining the Maze procedure during major cardiac surgeries has been widely spread in clinical practice. The technical evolution of the Maze procedure was targeted to ease of performance and simplification, such as replacing “cut-and-sew” with ablation lines using various energy sources, and modification of lesion sets to simpler ones [