The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium

Background: Low radiofrequency powers are commonly used on the posterior wall of the left atrium for atrial fibrillation ablation to prevent esophageal damage. Compared with higher powers, they require longer ablation durations to achieve a target lesion size index (LSI). Esophageal heating during ablation is the result of a time-dependent process of conductive heating produced by nearby radiofrequency delivery. This randomized study was conducted to compare risk of esophageal heating and acute procedure success of different LSI-guided ablation protocols combining higher or lower radiofrequency power and different target LSI values. Methods: Eighty consecutive patients were prospectively enrolled and randomized to one of 4 combinations of radiofrequency power and target LSI for ablation on the left atrium posterior wall (20 W/LSI 4, 20 W/LSI 5, 40 W/LSI 4, and 40 W/LSI 5). The primary end point of the study was the occurrence and number of esophageal temperature alerts per patient during ablation. Acute indicators of procedure success were considered as secondary end points. Long-term follow-up data were also collected for all patients. Results: Esophageal temperature alerts occurred in a similar proportion of patients in all groups. Significantly, shorter radiofrequency durations were required to achieve the target LSI in the 40 W groups. Less than 50% of the radiofrequency lesions reached the target LSI of 5 when using 20 W despite a longer radiofrequency duration. A lower rate of first-pass pulmonary vein isolation and a higher rate of acute pulmonary vein reconnection were recorded in the group 20 W/LSI 5. A lower atrial fibrillation recurrence rate was observed in the 40 W groups compared with the 20 W groups at 29 months follow-up. Conclusions: When guided by LSI, posterior wall ablation with 40 W is associated with a similar rate of esophageal temperature alerts and a lower atrial fibrillation recurrence rate at follow-up if compared with 20 W. These data will provide a basis to plan future randomized trials. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02619396.

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Effectiveness of Maze Procedure for Patients With Giant Left Atrium Associated With Mitral Valvular Disease

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84359-8 ◽

1998 ◽

Vol 31 (2) ◽

pp. 151A

Author(s):

S Yuda

Keyword(s):

Left Atrium ◽

Valvular Disease ◽

Maze Procedure ◽

Giant Left Atrium

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The Need for Consistent Predictors of Success for Surgical Ablation of Atrial Fibrillation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000426 ◽

2017 ◽

Vol 12 (6) ◽

pp. 421-429 ◽

Cited By ~ 4

Author(s):

Niv Ad ◽

Sari Diana Holmes ◽

Jay Patel ◽

Hyung Gon Je ◽

Deborah J. Shuman

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Left Atrium ◽

Meta Analysis ◽

Published Data ◽

Outcome Predictors ◽

Atrial Fibrillation Recurrence ◽

Recurrence Rates ◽

Surgical Ablation ◽

Ablation Success

Objective As with any medical therapy, identification of consistent and reliable outcome predictors is essential to understanding the efficacy of surgical ablation for atrial fibrillation. We originally intended to conduct a meta-analysis on atrial fibrillation surgical ablation to identify clinical factors that are most often associated with success. However, these studies are greatly heterogeneous. We conducted a systematic review to identify trends in outcome predictors and to provide recommendations for more uniform data analysis and reporting. Methods Relevant studies published between January 2005 and September 2013 were identified. To minimize heterogeneity, data were extracted only from multivariate analyses of outcome predictors. The initial approach for meta-analytic analyses was abandoned for a systematic review approach. Results From 604 initial citations, 19 studies with 5200 patients were included in the review. Systematic review of multivariable atrial fibrillation recurrence rates after surgical ablation revealed that studies were statistically heterogeneous, but atrial fibrillation recurrence after surgical ablation in mid-term follow-up was most often predicted by left atrium size, duration of atrial fibrillation, fine-wave atrial fibrillation, age of patient, and atrial fibrillation type. Conclusions The innate heterogeneity of published data precludes a meta-analysis for predictors of surgical ablation success. Of the few published studies that allow comparison, the most consistent predictors of failure were enlarged left atrium and long atrial fibrillation duration. These results underscore the need for consistent and reliable outcome predictors. We strongly recommend the development of a standardized system of measurement for consistent clinical parameters that can be used in outcome analyses for surgical ablation of atrial fibrillation.

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