Medium-term outcome of different surgical methods to cure atrial fibrillation: is less worse?

• Published in: Interactive cardiovascular and thoracic surgery Vol. 7; no. 2; pp. 201 - 206
• Main Authors: Geuzebroek, Guillaume S.C, Ballaux, Philippe K.E.W, van Hemel, Norbert M, Kelder, Johannes C, Defauw, Jo J.A.M.T
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01.04.2008
• Subjects: Aged; Atrial Appendage - surgery; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Atrial Flutter - etiology; Catheter Ablation - adverse effects; Catheter Ablation - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Odds Ratio; Pulmonary Veins - surgery; Recurrence; Research Design; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2007.159889

a Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands b Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands c Department of Cardiology, University of Utrecht, The Netherlands *Corresponding author. Koekoekslaan 1, 3430 EM Nieuwegein, The Netherlands. Tel.: +31-306099111; fax: +31-306092120. E-mail address : G.S.C.Geuzebroek{at}gmail.com (G.S.C. Geuzebroek). Different lesion sets and ablation techniques have been performed. We compared these outcomes in search of the best method. We performed a retrospective analysis of patients who have undergone AF surgery different from the maze III. The surgical lesion sets were pulmonary vein isolation (PVI) alone, left atrial maze (LAM) and bi-atrial maze (BAM) and were made with different ablation techniques. During surgery one patient died due to bleeding of a pulmonary vein. The number of patients in the PVI-, LAM-, BAM-groups was 12, 28 and 26, respectively, with freedom from AF at latest follow-up [22.0±15.6 (3.1–81.2) months] of 33%, 59% and 60%, respectively. Atrial flutter occurred less in the BAM-group (4%) than in the left-sided procedures (15.4%) ( P =0.231). Multivariate analysis demonstrated a higher recurrence of AF for PVI alone (OR 4.42, CL 0.95–20.6, P =0.0583) and a lower recurrence for the ‘cut-and-sew’ technique (OR 0.13, CL 0.030–0.60, P =0.0084). Left- and bi-atrial maze procedures are equally effective in the suppression of AF, whereas omission of right-sided lesions results in a higher prevalence of atrial flutter. The ‘cut-and-sew’ technique is superior in terms of freedom from AF compared to bipolar and unipolar radiofrequency. Key Words: Atrial fibrillation; Rhythm surgery; Maze; Arrhythmia Related Article eComment: Bilateral atrial appendage excision should be performed routinely in the surgical treatment of atrial fibrillation Bachar El Oumeiri, Parla Astarci, and Valérie Lacroix Interactive CardioVascular and Thoracic Surgery 2008 7: 205-206. [Full Text] [PDF]