One-year clinical and echocardiographic follow-up after endocardial radiofrequency ablation for atrial fibrillation during mitral valve surgery

Georges Fayad, Thierry Le Tourneau, Thomas Modine, Richard Azzaoui, Benoit Larrue, Dorothée Koussa, Gassan Naja, Christophe Decoenne, Henri Warembourg
2003 Journal of the American College of Cardiology  
Atrial fibrillatkx? (AF) is associated with adverse events particularly in mitral valve (MV) disease. Surgical radiofrequency (RF)ablation might be an interesting alternative to the Maze procedure for treatment of AF in MV disease. Methods: Over the past two years. 58 patients (pts, 65+10 years) operated on for mitral regurgitation (36) or stenosis (22) with either chronic (41) or paroxystlc (17) AF benefited in the same time for RF ablation. RF ablation was realized on the endocardial layer
more » ... ng a eight tip RF probe. Cardiac rhythm was evaluated at 3. 6 and 12 months with clinlcal examination, patient questtonlng, and ECG. A 24 hours ECG record was performed after 6 months. Echocardiographlc examination, including left and right atrial function. tricuspid and mitral transvalvular flow velocities was performed before operation, 7 days, 3 months, and within 1 years after operation. Results: Pts of the chronic group were significantly older, had a longer period of AF (p=O.O2) and a greater left atrium (p=O,OO3) compared with the paroxystlc group. Surgical RF ablation was performed in the left atria (55) or in both atriums (3). MV surgery consisted in MV repair I" 11 pts, and MV replacement in 47 pts (mechanical prosthesis. 28, bloprosthesis: 19). Mean antiarythmlc procedure duration was 19i6 min, and aortic cross clamp time 121+27 min. Post-operative complications were 1 death from multiorgan failure, 1 permanent atrioventricular block requiring a pacemaker implantation, and a circonflex artery stenosis. At 6 months 67% Of pts were free of arrythmia, 33% experienced at least one access of supraventricular arrythmia, and only 12% had several recurrences. Antiarrythmic drugs were withdrawn in 25% of pts. Left and right atrial contraction were effective in 84% of pts on the basis of doppler transvalvular A wave. Conclwon: RF ablation for AF during MV surgery is an effective and simple procedure resulting in persistent smus rhythm after 1 year. This procedure preserve atrlal contraction and might allow wthdrawal of antiarrythmic and anttcoagulant drugs. Background: Saphenous vein graft (SVG) occlusion remains a persistent complication of coronary bypass grafting (CABG). Conduits such as the internal mammary and radial arteries have been promoted as useful alternatives to SVG bypasses, a risk profile useful I" delineating contributors to SVG occlusion would consequently be helpful in planning for the use of alternative conduits. Methods: Potential predictors of SVG occlusion were evaluated for all patients (M:F, 69:31; mean age = 64 + 11 years) undergoing CABG at our institution since 1995. Post-CABG anglographic data were added to a prospectively maintained database(n=lOO patients, total number of grafts=318). Patients were included in this study if the graft target territory was a vein (left anterior descending (LAD), circumflex (Cx). right coronary artery (RCA)) rather than an alternative arterial conduit (right and left internal mammaries). The generaltzed estimating equation method was implemented to evaluate risk factors for SVG occlusion (partial/full occlusion vs. patent). Potential graft-and patientspecific risk factors for occlusion included: target artery caliber (<=1.5 vs. 2.0). vein quality (poor/fair vs. good), graft target territory , gender, age, ejection fraction (50), diabetes, obesity. family history, hypercholesterolemia. smoking, and hypertension. Results: Median time to post-op cath was 24 2 22 months (interquartile range, 6-37 months). Median SVG patency was 50% (O-100%). compared to internal mammary artery patency of 91%. Target graft territory was associated with increased SVG occlusion: unadjusted odds ratio Cx vs. LAD, 1.56 (95% C.l.=O.75-3.27); RCA vs. LAD, 0.70 (0.36-I 35); Cx vs. RCA, 2.24 (1.22-4.10). The only other vein specific risk factor for occlusion was vein quality: unadjusted odds ratio, 1.6 (0.89-2.86). Patient-specific risk factors wth a trend towards association (p < 0.25) with increased SVG occlusion included: gender (female vsmale). 1.87 (0.99-3.56); diabetes, 1.72 (0.88-3.35); and family hlstory. 1.45 (0.80, 2.65). Conclusions: Alternative conduits should be considered for saphenous vein grafts with a poor likelihood of patency.
doi:10.1016/s0735-1097(03)82714-6 fatcat:bq3y4mtkh5fz7jm6yhyrsu5vq4