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Thorac Cardiovasc Surg 2006; 54(2): 91-95
DOI: 10.1055/s-2005-872860
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Permanent Atrial Fibrillation Ablation Surgery in CABG and Aortic Valve Patients is at Least as Effective as in Mitral Valve Disease

S. Geidel1 , J. Ostermeyer1 , M. Laß1 , M. Geisler1 , N. Kotetishvili1 , H. Aslan1 , S. Boczor2 , K.-H. Kuck2
  • 1Abteilung für Herzchirurgie, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
  • 2Abteilung für Kardiologie, Allgemeines Krankenhaus St. Georg, Hamburg, Germany
Presented at the 34th DGTHG Annual Meeting, Hamburg, February 16, 2005
Further Information

Publication History

Received February 21, 2005

Publication Date:
15 March 2006 (online)

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Abstract

Background: Data on combined permanent atrial fibrillation (pAF) surgery and coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) are scarce, and the mid- and long-term effects on survival and cardiac rhythm are unknown. Material and Methods: In a prospective analysis 125 patients (Group I: CABG and/or AVR, n = 50; Group II: mitral valve [MV] surgery, n = 75) with pAF (≥ 6 months) underwent either concomitant monopolar (Group I: n = 20; Group II: n = 75) or bipolar (Group I: n = 30) radiofrequency (RF) ablation procedures. Group I patients had a significantly smaller left atrial (LA) size than Group II patients (LA-diameter: 47.7 ± 4.6 vs. 58.2 ± 6.1 mm; p < 0.01). Regular follow-up was performed from 3 to 36 months after surgery to assess survival, NYHA-class, and conversion rate to stable sinus rhythm (SR). Results: Early mortality (< 30 days) of Group I patients was 0 % (Group II: 2.7 %), cumulative survival at long-term follow-up was 0.95 vs. 0.82 (p = 0.31) and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At follow-up 80 % of Group I patients had SR (Group II: 70 %). In Group I patients the bipolar approach was associated with significantly shorter ablation procedure times compared to the monopolar procedure (12.1 ± 3.4 vs. 18.9 ± 1.6 min; p < 0.05). Conclusions: Concomitant pAF ablation surgery in CABG and/or AVR is safe and at least as effective as in MV surgery, presumably because severe LA enlargement is exceptionally rare in this group.

Key words

Atrial fibrillation - atrial fibrillation surgery - radiofrequency ablation - arrhythmia surgery - bipolar radiofrequency ablation

References

  • 1 Geidel S, Lass M, Boczor S, Kuck K H, Ostermeyer J. Surgical treatment of permanent atrial fibrillation during heart valve surgery.  Interactive Cardiovascular and Thoracic Surgery. 2003;  2 160-165
    CrossrefPubMedSearch in Google Scholar
  • 2 Geidel S, Ostermeyer, Lass J M, Boczor S, Kuck K H. Surgical treatment of permanent atrial fibrillation during cardiac surgery using monopolar and bipolar radiofrequency.  Indian Pacing Electrophysiol J. 2003;  3 93-100
    PubMedSearch in Google Scholar
  • 3 Geidel S, Ostermeyer J, Lass M. et al . Three years experience with monopolar and bipolar radiofrequency ablation surgery in patients with permanent atrial fibrillation.  Eur J Cardiothorac Surg. 2005;  27 243-249
    CrossrefPubMedSearch in Google Scholar
  • 4 Kalmar P, Irrgang E. Cardiac surgery in Germany during 2003: A report by the German Society for Thoracic and Cardiovascular Surgery.  Thorac Cardiovasc Surg. 2004;  52 312-317
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Fuster V, Ryden L E, Asinger R W. et al . ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (committee to develop guidelines for the management of patients with atrial fibrillation).  Circulation. 2001;  104 2118-2150
    PubMedSearch in Google Scholar
  • 6 Ryder K M, Benjamin E J. Epidemiology and significance of atrial fibrillation.  Am J Cardiol. 1999;  84 131R-138R
    CrossrefPubMedSearch in Google Scholar
  • 7 Allessie M A. Atrial fibrillation-induced atrial remodeling in humans: what is the next step?.  Cardiovasc Res. 1999;  44 10-12
    CrossrefPubMedSearch in Google Scholar
  • 8 Moe G K. On the multiple wavelet hypothesis of atrial fibrillation.  Arch Int Pharmacodyn Ther. 1962;  140 183-188
    PubMedSearch in Google Scholar
  • 9 Cox J L. The role of surgical intervention in the management of atrial fibrillation.  Tex Heart Inst J. 2004;  31 257-265
    PubMedSearch in Google Scholar
  • 10 Haissaguerre M, Jais P, Shah D C. et al . Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins.  N Engl J Med. 1998;  339 659-666
    CrossrefPubMedSearch in Google Scholar
  • 11 Roy D, Talajic M, Dorian P. et al . Amiodarone to prevent recurrence of atrial fibrillation.  N Engl J Med. 2000;  342 913-920
    CrossrefPubMedSearch in Google Scholar
  • 12 Benussi S, Pappone C, Nascimbene S. et al . A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach.  Eur J Cardiothorac Surg. 2000;  17 524-529
    CrossrefPubMedSearch in Google Scholar
  • 13 Biffi M, Boriani G. Atrial remodeling: evolving concepts.  IPEJ. 2003;  3 81-92
    PubMedSearch in Google Scholar
  • 14 Khargi K, Laczkovics A, Haardt H. et al .Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation in CABG and AVR patients are as effective as in mitral valve patients. Read at the 3rd EACTS/ESTS Joint Meeting. Leipzig, Germany; 15th.September.2004
    Search in Google Scholar

Dr. med. Stephan Geidel

Department of Cardiac Surgery

Lohmuehlenstraße 5

20099 Hamburg

Germany

Phone: + 494028904150/4151

Fax: + 49 40 28 90 41 84

Email: StGeidel@aol.com

Email: Stephan.Geidel@ak-stgeorg.lbk-hh.de