Anticoagulation after Surgical Ablation for Atrial Fibrillation: Over-treatment and Under-treatment of patients who have undergone mitral valve surgery and concomitant Cox-Maze procedure

Background. Atrial fibrillation surgical radiofrequency ablation (AFSA) during mitral valve surgery (MVS) has almost completely superseded the Cox-Maze procedure for the treatment of atrial fibrillation. Methods. We retrospectively analyzed 100 patients who underwent MVS + AFSA in our institution from January 2008 to June 2017. We compared the effectiveness of AFSA in patients who underwent LAA exclusion to those who did not. Moreover, we analyzed the role of preoperative AF duration (≤ or >1 year) and medial-lateral left atrial dimensions (ML-LAD) (≤ or >6 cm). The efficacy endpoint was freedom from AF at discharge and at 2-year follow-up. The safety endpoints were need of a permanent pacemaker (PMK), surgical re-exploration, occurrence of stroke, and left circumflex artery or esophageal lesions. Results. Overall, the rate of AF freedom was 69% at discharge and 80% at 2-year follow-up. LAA exclusion did not influence AF freedom at 2-year follow-up, and 84.6% of patients who underwent LAA exclusion were in the sinus rythm (SR) at 2 year compared to 75% of those who did not receive LAA exclusion free from AF as well ( p = 0.230 ). AF duration ≤1 or >1 year did not influence sinus rhythm (SR) maintenance (85.7% vs. 75.8%; p = 0.224 ), and in these two groups, LAA exclusion did not change the efficacy of AFSA. ML-LAD ≤ 6 cm was associated with better results in terms of SR maintenance. A statistically significant association between LAA exclusion and SR maintenance at 2-year follow-up ( p = 0.017 ) was found among patients with ML-LAD ≤ 6 cm. Complications included 7 cases of PMK implantation, 2 cases of surgical re-exploration, and 1 case of stroke. No circumflex artery or esophageal lesions occurred after surgical procedures. Conclusions. In our experience, AFSA during isolated MVS resulted in good outcomes in terms of SR maintenance and incidence of complications. AF duration ≤ 1 year did not influence results, while patients with ML-LAD ≤ 6 cm had significantly better results regarding SR at follow-up. In patients with ML-LAD ≤ 6 cm, LAA exclusion significantly increased the success rate of SR maintenance at 2-year follow-up.

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Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial.

10.21203/rs.3.rs-27973/v2 ◽

2020 ◽

Author(s):

Gabriella Boano ◽

Meriam Åström Aneq ◽

Giannis Spyrou ◽

Helena Enocsson ◽

Charitakis Emmanouil ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Myocardial Injury ◽

Troponin T ◽

Controlled Trial ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cell Stress ◽

Surgical Ablation ◽

Apoptotic Activity

Abstract Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS). Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n=20) or radiofrequency (n=21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points. Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12805 [6140–15700] vs. 2790 [1880–4180] ng/L; P=0.002 and 271 [217–357] vs. 79 [66–93] µg/L; P<0.001, respectively). Both groups had significantly higher levels than the no-ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs=0.41, P=0.001) and NT-proBNP (rs=0.48, P<0.001). Protease-activated receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly increased in the cryoablation group. Conclusions: Cryoablation results in a larger myocardial injury and possibly more elevated apoptotic activity and cell stress compared with the RF technique. The type of ablation device did not have any significant influence on the postoperative inflammatory response nor on the early postoperative levels of NT-proBNP.Trial registration: DOI:10.1186/ISRCTN14454361. Registered 16 November 2014 – Retrospectively registered, http://www.isrctn.com/ISRCTN14454361

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Efficacy of Cut-and-Sew Surgical Ablation for Atrial Fibrillation in Patients With Giant Left Atria Undergoing Mitral Valve Surgery: A Propensity-Matched Analysis

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2019.05.004 ◽

2019 ◽

Vol 31 (4) ◽

pp. 796-802 ◽

Cited By ~ 2

Author(s):

Huishan Wang ◽

Jinsong Han ◽

Zengwei Wang ◽

Zongtao Yin ◽

Zhigang Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Surgical Ablation

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Surgical Ablation of Atrial Fibrillation During Mitral Valve Surgery: A Systematic Review of the Literature

Heart Lung and Circulation ◽

10.1016/j.hlc.2017.03.092 ◽

2017 ◽

Vol 26 ◽

pp. S384

Author(s):

Satyanarayan Shanbhag ◽

Alireza Kashani ◽

Yuvaraj Davidson ◽

Parma Nand ◽

Indran Ramanathan

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Review Of The Literature ◽

Surgical Ablation

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Bipolar versus unipolar energy in the surgical ablation of atrial fibrillation in patients with mitral valve surgery

Heart Vessels and Transplantation ◽

10.24969/hvt.2018.81 ◽

2018 ◽

Vol 2 (Issue 4) ◽

pp. 106

Author(s):

Leonardo Canale ◽

Bruno Azevedo ◽

Marcelo Goulart Correia ◽

Ernesto Chavez ◽

Erica Macedo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Sinus Rhythm ◽

Valve Replacement ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Left Ventricular Ejection ◽

Surgical Ablation ◽

Bipolar Radiofrequency ◽

Bipolar Energy

Objective: To evaluate the presence of sinus rhythm or atrial fibrillation (AF) in patients who had mitral valve surgery with concomitant surgical ablation of AF, by unipolar or bipolar radiofrequency. Methods: Adults patients who had mitral valve replacement or mitral valvuloplasty with concomitant surgical ablation of AF, either by unipolar or bipolar radiofrequency, were consecutively included between the 2008 and 2012. Surgery was done by conventional median sternotomy. Results: A total of 99 patients were included; 20 (20.2%) had surgical ablation by unipolar energy and 79 (79.8%) by bipolar energy. There were 76 (76.8%) women, and mean age± SD was 51 ±11 years. The median duration of AF before surgery was 41 months. Type of AF was paroxysmal in 21 (21%), persistent in 11 (11%), and long-standing persistent in 67 (67%). Mean left atrium size in the preoperative period was 5.54 ± 0.82 cm. Mean left ventricular ejection fraction was 58±12.4%. Types of mitral valve surgery were valvuloplasty (n=10), mechanical valve replacement in 30, and bioprosthesis replacement in 59. Concomitant tricuspid annuloplasty was performed in 39 patients. Thirty- day mortality was 8/99 (8%). Mean follow-up time was 1274 days (3.49 years). Survival was 92%. After 4 years no patient who had had unipolar ablation was in sinus rhythm, whilst 67% of those who had bipolar energy ablation were in sinus rhythm (p<0.001). Conclusion: The use of bipolar energy is superior to unipolar energy in the surgical ablation of atrial fibrillation in patients submitted to mitral valve surgery.

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