Concomitant atrial fibrillation ablation with valve procedures for patients with left atrium enlarged from 60 mm to 70 mm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yiming ¹ , XU Ming ² , WANG Liming ² , HUANG Fuhua ² , JIANG Yingshuo ² , QIU Zhibing ² , XIANG Fei ² ,  CHEN Xin ²

1. School of Medicine, Southeast University Medical College, Nanjing, 210009, P.R.China;
2. Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Southeast University Medical College, Nanjing, 210006, P.R.China;

Corresponding author：

CHEN Xin, Email: stevecx1@163.com

Keywords：

Atrial fibrillation; ablation; cardioversion; left atrium

DOI：

10.7507/1007-4848.201611039

Video：

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Objective To explore the operability of concomitant ablation for the patients with valvular heart diseases with left atrium bigger than 60 mm. Methods We prospectively included 306 patients with concomitant ablation in our hospital between 2013 and 2015 year. Based on diameter of left atrium measured by intra-operative transesophageal echocardiography (TEE), we separated these patients into two groups including a group L (left atrium >60 mm, 93 patients, 55 males and 38 females at age of 57.0±10.1 years) and a group S (left atrium <60 mm, 213 patients, 120 males and 93 females at age of 55.2±9.9 years) and followed them on 4 time points (time on discharge, three months, six months, and one year after surgery). Then, we analyzed the impact of left atrial size on cardioversion outcome of surgical ablation based on the following data. Results The successful rate of the group S and the group L in the 4 time points was 72.8% vs. 75.3%, 74.2% vs. 75.3%, 78.9% vs. 77.4%, and 77.0% vs. 77.4%, respectively . The result of both univariate logistic regression analysis and receiver operation characteristic(ROC) curve analysis showed that there was no statistical difference in cardioversion rates between the group S and the group L. And there was no evident correlation between size of left atrium and ablation failure. Conclusion Patients with left atrium enlarged from 60 mm to 70 mm can achieve the same satisfactory results in cardioversion, and should not be the contraindication of concomitant surgical ablation.

Citation： LIU Yiming, XU Ming, WANG Liming, HUANG Fuhua, JIANG Yingshuo, QIU Zhibing, XIANG Fei, CHEN Xin. Concomitant atrial fibrillation ablation with valve procedures for patients with left atrium enlarged from 60 mm to 70 mm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 518-521. doi: 10.7507/1007-4848.201611039 Copy

1.	Cox JL, Schuessler RB, D’Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4): 569-583.
2.	Gaynor SL, Diodato MD, Prasad SM, et al. A prospective, single-center clinical trial of a modified cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg, 2004, 128(4): 535-542.
3.	Gillinov AM, McCarthy PM, Blackstone EH, et al. Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. J Thorac Cardiovasc Surg, 2005, 129(6): 1322-1329.
4.	Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace, 2012, 14(4): 528-606.
5.	Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
6.	Badhwar V, Rankin JS, Damiano RJ Jr, et al. The society of thoracic surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
7.	Damiano RJ Jr, Schwartz FH, Bailey MS, et al. The Cox Maze Ⅳ procedure: predictors of late recurrence. J Thorac Cardiovasc Surg, 2011, 141(1): 113-121.
8.	Romano MA, Bach DS, Pagani FD, et al. Atrial reduction plasty Cox Maze procedure: extended indications for atrial fibrillation surgery. Ann Thorac Surg, 2004, 77(4): 1282-1287.
9.	Gillinov AM, Sirak J, Blackstone EH, et al. The Cox Maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(6): 1653-1660.
10.	Gaynor SL, Schuessler RB, Bailey MS, et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg, 2005, 129(1): 104-111.
11.	Pecha S, Hakmi S, Subbotina I, et al. Concomitant surgical ablation for atrial fibrillation (AF) in patients with significant atrial dilation >55 mm. Worth the effort? J Cardiothorac Surg, 2015, 10: 165. doi: 10.1186/s13019-015-0337-3.
12.	Ad N, Henry L, Hunt S, et al. Should surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium? J Thorac Cardiovasc Surg, 2014, 147(1): 236-241.
13.	January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. Circulation, 2014, 130(23): e199-e267.
14.	Sunderland N, Maruthappu M, Nagendran M. What size of left atrium significantly impairs the success of Maze surgery for atrial fibrillation? Interact Cardiovasc Thorac Surg, 2011, 13(3): 332-338.
15.	Qian Y, Meng J, Tang H, et al. Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases. Europace, 2010, 12(3): 371-377.
16.	Schotten U, Verheule S, Kirchhof P, et al. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev, 2011, 91(1): 265-325.

1. Cox JL, Schuessler RB, D’Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4): 569-583.
2. Gaynor SL, Diodato MD, Prasad SM, et al. A prospective, single-center clinical trial of a modified cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg, 2004, 128(4): 535-542.
3. Gillinov AM, McCarthy PM, Blackstone EH, et al. Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. J Thorac Cardiovasc Surg, 2005, 129(6): 1322-1329.
4. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace, 2012, 14(4): 528-606.
5. Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
6. Badhwar V, Rankin JS, Damiano RJ Jr, et al. The society of thoracic surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
7. Damiano RJ Jr, Schwartz FH, Bailey MS, et al. The Cox Maze Ⅳ procedure: predictors of late recurrence. J Thorac Cardiovasc Surg, 2011, 141(1): 113-121.
8. Romano MA, Bach DS, Pagani FD, et al. Atrial reduction plasty Cox Maze procedure: extended indications for atrial fibrillation surgery. Ann Thorac Surg, 2004, 77(4): 1282-1287.
9. Gillinov AM, Sirak J, Blackstone EH, et al. The Cox Maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(6): 1653-1660.
10. Gaynor SL, Schuessler RB, Bailey MS, et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg, 2005, 129(1): 104-111.
11. Pecha S, Hakmi S, Subbotina I, et al. Concomitant surgical ablation for atrial fibrillation (AF) in patients with significant atrial dilation >55 mm. Worth the effort? J Cardiothorac Surg, 2015, 10: 165. doi: 10.1186/s13019-015-0337-3.
12. Ad N, Henry L, Hunt S, et al. Should surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium? J Thorac Cardiovasc Surg, 2014, 147(1): 236-241.
13. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. Circulation, 2014, 130(23): e199-e267.
14. Sunderland N, Maruthappu M, Nagendran M. What size of left atrium significantly impairs the success of Maze surgery for atrial fibrillation? Interact Cardiovasc Thorac Surg, 2011, 13(3): 332-338.
15. Qian Y, Meng J, Tang H, et al. Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases. Europace, 2010, 12(3): 371-377.
16. Schotten U, Verheule S, Kirchhof P, et al. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev, 2011, 91(1): 265-325.

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Concomitant atrial fibrillation ablation with valve procedures for patients with left atrium enlarged from 60 mm to 70 mm

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