Key result
Adding ablation and atrioplasty to mitral surgery linked to ~130% higher 3-year sinus rhythm restoration.
Why the study?
The effectiveness of one-stage mitral valve correction combined with surgical radiofrequency ablation and left atrial atrioplasty for sinus rhythm restoration and its failure predictors was evaluated.
Does one-stage mitral valve correction, surgical radiofrequency ablation, and left atrial atrioplasty improve sinus rhythm restoration compared to mitral valve correction alone in patients with mitral valve disease?
Cohort (n=123)
No
Does one-stage mitral valve correction, surgical radiofrequency ablation, and left atrial atrioplasty improve sinus rhythm restoration compared to mitral valve correction alone in patients with mitral valve disease?
Combining mitral valve correction with surgical radiofrequency ablation and left atrial atrioplasty significantly improves long-term sinus rhythm maintenance compared to mitral valve surgery alone.
Supports combined ablation and atrioplasty with mitral valve surgery; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: Our aim was to evaluate sinus rhythm restoration and its failure predictors after one-stage application of surgical radiofrequency ablation, left atrial reduction and mitral valve correction. METHODS: This is a prospective longitudinal cohort study with historical controls. Patients were divided into 2 groups according to the performed type of operation--the main group included patients undergone one-stage mitral valve correction, surgical radiofrequency ablation and left atrial atrioplasty (n = 47); and the control group consisted of patients undergone only mitral valve correction (n = 76). Surgical radiofrequency ablation was performed under the scheme Maze-IV. Left atrial atrioplasty procedure was performed according to echocardiography data: if in women LA antero-posterior dimensions were more than 4.7 cm and in men more than 5.2 cm. RESULTS: The study included 123 patients. In the main group (age of the patients 61.0 ± 9.1 years, 55% male) sinus rhythm restoration was observed in 32 (68%) patients during the early postoperative period, but at the time of discharge it reduced to 19 (40%), but in 6 months it increased up to 37 (78%), and in 36 months sinus rhythm already was detected in 40 (85%) patients. At the same time, during the early postoperative period in the control group (patients aged 59.0 ± 11.0 years, 61% male) only 31 (40%) of patients had sinus rhythm, in 6 months it was detected in 11 (14%) cases, and in 36 months sinus rhythm--only in 28 (37%) patients. Predictors of atrial fibrillation recurrence were revealed: valve disease continuance < 4 years (p = 0.017) and atrial fibrillation history < 3 years (p =0.029). CONCLUSION: One-stage peforming of mitral valve correction, surgical radiofrequency ablation and left atrial atrioplasty restores and maintains more regular sinus rhythm, even in presence of atrial fibrillation recurrence predictors.
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Joshibayev et al. (2015) conducted a cohort in Mitral valve disease with atrial fibrillation and enlarged left atrium (n=123). One-stage mitral valve correction, surgical radiofrequency ablation, and left atrial atrioplasty vs. Mitral valve correction alone was evaluated on Sinus rhythm restoration at 36 months. One-stage application of mitral valve correction, surgical radiofrequency ablation, and left atrial atrioplasty restored sinus rhythm in 85% of patients at 36 months compared to 37% with mitral valve correction alone.
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