Why the study?
Left atrial enlargement and fibrosis are linked to AF pathogenesis, prompting the introduction of a novel concept and new procedure for AF treatment based on these characteristics.
Does left atrial geometric volume reduction combined with left appendage base closure improve procedural and clinical outcomes compared to the Cox-Maze IV procedure in patients with mitral valve disease and long-standing persistent AF?
Does left atrial geometric volume reduction combined with left appendage base closure improve procedural and clinical outcomes compared to the Cox-Maze IV procedure in patients with mitral valve disease and long-standing persistent AF?
A novel left atrial geometric volume reduction procedure combined with left appendage base closure may offer shorter procedural times, lower costs, and better functional recovery than the Cox-Maze IV procedure for AF associated with mitral valve disease.
May support targeted LA intervention in mitral valve AF; hypothesis-generating and requires prospective validation.
BACKGROUND: Left atrial enlargement and fibrosis have been linked to the pathogenesis of atrial fibrillation (AF). The authors aimed to introduce a novel concept and develop a new procedure for AF treatment based on these characteristics. METHODS: The study included three stages. The first stage was a descriptive study to clarify the characteristics of the left atrial enlargement and fibrosis' distribution in patients with mitral valve disease and long-standing persistent AF. Based on these characteristics, the authors introduced a novel concept for AF treatment, and then translated it into a new procedure. The second stage was a proof-of-concept study with this new procedure. The third stage was a comparative effectiveness research to compare the clinical outcomes between patients with this new procedure and those who received Cox-Maze IV treatment. RESULTS: Based on the nonuniform fashion of left atrial enlargement and fibrosis' distribution, the authors introduced a novel concept: reconstructing a left atrium with appropriate geometry and uniform fibrosis' distribution for proper cardiac conduction, and translated it into a new procedure: left atrial geometric volume reduction combined with left appendage base closure. As compared to the Cox-Maze IV procedure, the new procedure spent significantly shorter total surgery time, cardiopulmonary bypass time, and aortic cross-clamp time ( P <0.001). Besides, the new procedure was related to a shorter ICU stay period (odd ratio (OR)=0.45, 95% CI=0.26-0.78), lower costs (OR=0.15, 95% CI=0.08-0.29), and a higher rate of A wave of transmitral and transtricuspid flow reappearance (OR=1.76, 95% CI=1.02-3.04). CONCLUSIONS: The new procedure is safe and effective for eliminating AF associated with mitral valve disease.
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Chen et al. (2023) studied this question.
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