Key result
Aggressive left atrial volume reduction during surgical ablation of atrial fibrillation significantly reduced the risk of atrial fibrillation recurrence (HR 0.50) compared to no volume reduction.
Why the study?
An enlarged left atrium is a well-known risk factor for AF ablation failure, prompting evaluation of the effect of LA volume reduction during concomitant surgical AF ablation in patients with a giant LA.
Does aggressive left atrial volume reduction improve freedom from atrial fibrillation in patients with a giant left atrium undergoing surgical ablation and mitral valve surgery?
Cohort (n=116)
No
Does aggressive left atrial volume reduction improve freedom from atrial fibrillation in patients with a giant left atrium undergoing surgical ablation and mitral valve surgery?
Aggressive left atrial volume reduction during concomitant mitral valve surgery and surgical AF ablation significantly improves long-term maintenance of sinus rhythm in patients with a giant left atrium.
Answers are grounded in this paper and cite their sources.
May support LA reduction in giant atrium during mitral surgery with AF ablation; leaves open randomized confirmation.
Background: An enlarged left atrium (LA) is a well-known risk factor for ablation failure of atrial fibrillation (AF). We analyzed the result of concomitant AF ablation in patients with a giant LA and evaluated the effect of LA volume reduction. Methods: Between 2000 and 2011, 116 patients with a giant LA (antero-posterior dimension ≥70 mm) who underwent surgical AF ablation during MV surgery were retrospectively reviewed. Among these, 28 patients received aggressive LA volume reduction procedure (reduction group) while the other 88 patients received the surgery without LA volume reduction (non-reduction group). Mean follow-up duration was 6.8±3.0 years. Results: Aortic clamping and cardio-pulmonary bypass times were significantly longer in reduction group than non-reduction group (P<0.001 and 0.025, respectively). There were no significant differences in early mortality rates (3.7% vs. 5.7%, P>0.99) and major complication rates. Rates of freedom from AF at 1, 3 and 5 years were 84.2%, 74.3% and 54.5%, respectively in reduction group and 49.0%, 33.2% and 28.4%, respectively in non-reduction group (P=0.013). Multivariable analysis revealed severe pulmonary hypertension as an independent risk factor for AF recurrence (HR, 15.9; 95% CI, 1.69–149.54, P=0.015) while LA volume reduction (HR, 0.50; 95% CI, 0.28–0.89, P=0.018) and the use of cryoablation instead of radiofrequency (HR, 0.11; 95% CI, 0.01–0.95, P=0.045) were found to be protective against AF recurrence. Conclusions: Aggressive LA volume reduction was found to improve rhythm outcomes in patients with a giant LA undergoing surgical AF ablation.
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Kim et al. (2019) conducted a cohort in Atrial fibrillation with giant left atrium undergoing mitral valve surgery (n=116). Aggressive left atrial volume reduction (circumferential left atrial resection) vs. Surgical atrial fibrillation ablation without left atrial volume reduction was evaluated on Atrial fibrillation recurrence (HR 0.50, 95% CI 0.28-0.89, p=0.018). Aggressive left atrial volume reduction during surgical ablation of atrial fibrillation significantly reduced the risk of atrial fibrillation recurrence (HR 0.50) compared to no volume reduction.
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