Intraoperative radiofrequency ablation during mitral valve surgery resulted in 76% of surviving patients remaining in sinus rhythm at a mean follow-up of 20 months.
Observational (n=72)
Does intraoperative radiofrequency ablation restore sinus rhythm in patients with mitral valve disease and long-standing atrial fibrillation undergoing open-heart surgery?
Intraoperative radiofrequency ablation during mitral valve surgery is an effective, less invasive alternative to the traditional maze procedure for restoring sinus rhythm in patients with long-standing atrial fibrillation.
OBJECTIVE: Patients with mitral valve disease and suffering of atrial fibrillation of more than 1 year's duration have a low probability of remaining in sinus rhythm after valve surgery alone. Intraoperative radiofrequency ablation was used as an alternative to simplify the surgical maze procedure. METHODS: Seventy-two patients with mitral valve disease, aged 63+/-11 years ranging from 31 to 80 years, underwent valve surgery and radiofrequency energy applied endocardially, based on the maze III procedure to eliminate the arrhythmia. The right-sided maze was performed on the beating heart and the left-sided maze during aorta cross-clamping. RESULTS: Surgical procedures included mitral valve repair (n=38) or replacement (n=34) and in addition tricuspid valve repair (n=42), closure of an atrial septal defect (n=2) and correction of cor triatriatum (n=1). The left-sided maze needed 14+/-3 min extra ischemic time. There were two in-hospital deaths (2.7%) and three patients (4.2%) died during follow-up of 20+/-15 months. Among 67 surviving patients, 51 patients (76%) were in sinus rhythm, two patients (3%) had an atrial rhythm and eight patients (12%) had persistent atrial fibrillation or atrial flutter. Four patients had a pacemaker implanted, in one patient because of sinus node dysfunction. Doppler echocardiography in 64 patients demonstrated right atrial contractility in 89% and left atrial transport in 91% of patients. CONCLUSIONS: Intraoperative radiofrequency ablation of atrial fibrillation is an effective and less invasive alternative for the original maze procedure to eliminate atrial fibrillation.
Sie et al. (Sun,) realizaron un estudio observacional en enfermedad de la válvula mitral y fibrilación auricular (n=72). Se evaluó la ablación por radiofrecuencia intraoperatoria (procedimiento modificado de laberinto) en el ritmo sinusal en el seguimiento. La ablación por radiofrecuencia intraoperatoria durante la cirugía de la válvula mitral resultó en que el 76% de los pacientes sobrevivientes permanecieran en ritmo sinusal a un seguimiento medio de 20 meses.
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