Key result
Surgical PVI during mitral surgery yields only ~30% 5-year freedom from long-standing persistent AF.
Why the study?
The long-term outcome of pulmonary vein isolation for long-standing persistent atrial fibrillation in patients with rheumatic mitral valve disease was unclear.
Does surgical pulmonary vein isolation prevent atrial fibrillation recurrence in patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation?
Cohort (n=100)
Does surgical pulmonary vein isolation prevent atrial fibrillation recurrence in patients with rheumatic mitral valve disease and long-standing persistent atrial fibrillation?
Simple surgical pulmonary vein isolation is insufficient to maintain sinus rhythm in patients with long-standing persistent atrial fibrillation undergoing rheumatic mitral valve surgery.
Simple PVI during mitral valve surgery linked to high long-term AF recurrence in rheumatic disease; leaves open need for adjunctive lesions in trials.
BACKGROUND: Pulmonary vein isolation has been employed to eliminate paroxysmal atrial fibrillation. However, the long-term outcome in terms of long-standing persistent atrial fibrillation is unclear. METHODS: One hundred patients with rheumatic mitral valve disease and long-standing (>1 year) persistent atrial fibrillation were operated on between July 1998 and June 2007. Mitral valve surgery and surgical isolation (cut-and-sew) of the pulmonary veins were performed in all cases. Transthoracic echocardiography and 24-h Holter monitoring were obtained after 3 and 6 months and yearly thereafter. RESULTS: Early and late follow-up was 99% and 92% complete, respectively. The endpoint was freedom from atrial fibrillation. There was one (1%) hospital death. Atrial fibrillation was present in 39%, 47%, 63% and 68% of patients at 3 months, 1 year, 3 years, and 5 years after surgery, respectively. The odds ratios for recurrence of atrial fibrillation postoperatively were 1.41 (95% confidence interval 1.14-1.74), 2.17 (95% confidence interval 1.63-2.90), and 3.62 (95% confidence interval 2.44-5.38) at 1 week, 3 years, and 5 years, respectively. Actuarial freedom from atrial fibrillation was 35% at 3 years, and 30% at 5 years. A direct relationship was observed between preoperative left atrial size >6 cm and atrial fibrillation recurrence at 5 years (p < 0.05 odds ratio = 2.5, 95% confidence interval 1.15 - 5.4). CONCLUSIONS: No beneficial effects of simple pulmonary vein isolation for long-standing persistent atrial fibrillation concomitant with rheumatic mitral valve disease were observed. Atrial fibrillation cannot be fully treated using only pulmonary vein isolation.
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Ovidio A Garcı́a-Villarreal (2015) conducted a cohort in Rheumatic mitral valve disease and long-standing persistent atrial fibrillation (n=100). Surgical isolation (cut-and-sew) of the pulmonary veins during mitral valve surgery was evaluated on Freedom from atrial fibrillation. Surgical pulmonary vein isolation during mitral valve surgery for long-standing persistent atrial fibrillation yielded poor long-term results, with only 30% actuarial freedom from AF at 5 years.
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