Key result
Radiofrequency pulmonary vein isolation yielded a higher incidence of recurrent atrial fibrillation than conventional surgery.
Why the study?
Does radiofrequency pulmonary veins isolation improve the efficacy of electrical block lines and reduce recurrent atrial fibrillation compared to conventional surgical cut and sew in patients with chronic permanent atrial fibrillation undergoing mitral valve surgery?
RCT (n=22)
Randomized
Does radiofrequency pulmonary veins isolation improve the efficacy of electrical block lines and reduce recurrent atrial fibrillation compared to conventional surgical cut and sew in patients with chronic permanent atrial fibrillation undergoing mitral valve surgery?
Conventional surgical cut and sew pulmonary vein isolation forms more effective electrical block lines and results in significantly lower rates of recurrent atrial fibrillation compared to radiofrequency ablation in patients with chronic permanent AF undergoing mitral valve surgery.
Answers are grounded in this paper and cite their sources.
Conventional cut-and-sew PVI should be preferred over radiofrequency ablation to reduce recurrent AF after mitral valve surgery; challenges routine RF use in permanent AF.
Background: Surgical pulmonary veins isolation (PVI) is done to restore sinus rhythm (SR) in patients with chronic permanent atrial fibrillation (CPAF) and mitral valve disease. Here we compare the efficacy of electrical block lines performed with radiofrequency (RF) compared with conventional surgery. Methods: Randomized trial of 22 patients with CPAF and indication for mitral valve surgery. Ten patients underwent conventional surgery (SURG) and 12 RF. To prove the efficacy of the blockage lines, epicardial pacemaker wires were placed in the isolated pulmonary veins region (IPVR) and right atria (RA). Results: There were no differences in the baseline data among the groups. All patients remained in SR during the immediate postoperative period. Block lines were tested in patients who remained in SR during the following days (eight in SURG and nine in RF). The median value of thresholds to conduct the stimulus of IPVR for the RA was 18 mA in SURG and 3 mA in RF (P < 0.022). Eight SURG patients and seven RF patients (P < 0.38) remained in SR at hospital discharge. Eleven RF patients and one SURG required amiodarone to maintain SR (P < 0.001). The incidence of recurrent atrial fibrillation (AF) in the follow-up was 10.7/100 patients/year in the SURG group versus 73.1/100 patients/year in the RF group (P = 0.009). Conclusions: PVI by SURG formed more effective block lines than RF. SR at hospital discharge was similar among the groups, but more amiodarone was used in RF. During follow-up, incidence of recurrent AF was higher in the RF group. (PACE 2010; 33:1249–1257)
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Pires et al. (2010) conducted an RCT in Chronic permanent atrial fibrillation and mitral valve disease (n=22). Radiofrequency pulmonary veins isolation vs. Conventional surgery (cut and sew) was evaluated on Incidence of recurrent atrial fibrillation (p=0.009). Radiofrequency pulmonary vein isolation yielded a higher incidence of recurrent atrial fibrillation than conventional surgery.
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