BACKGROUND: The purpose of this study was to compare the clinical and rhythm outcomes between left atrial ablation and biatrial ablation in patients with atrial fibrillation-associated mitral valve diseases. METHODS: Data were collected on 284 patients who underwent left atrial ablation (n = 85) or biatrial ablation (n = 199) of atrial fibrillation using a cryoablation system combined with mitral operation from 2006 through 2009. Outcomes were compared using a propensity score study design based on 20 baseline patient characteristics. RESULTS: In baseline characteristics, patients in the biatrial group were more likely to have higher risk clinical and echocardiographic profiles than patients in the left atrial group. There were 2 early deaths (0.7%), 1 in each group, and 5 cases of permanent pacemaker implantation (1.8%) only in the biatrial group. Follow-up was complete in 95.1% (n = 270). During a mean follow-up duration of 26.0 ± 13.3 months, there were 12 late deaths (1 in the left atrial group, 11 in the biatrial group). Cumulative incidence of atrial fibrillation in the absence of antiarrhythmic medications at 2 years was 25.9% ± 5.8% in the left atrial group and 14.3% ± 2.8% in the biatrial group (adjusted hazard ratio 3.06, 95% confidence interval: 1.41 to 6.66, p = 0.005). Major adverse events included stroke in 1, cardiac reoperation in 3, and anticoagulation-related hemorrhages in 16, infective endocarditis in 1, and mechanical valve thrombosis in 1, with no significant intergroup differences in major event-free survival rate (p = 0.73). CONCLUSIONS: Compared with left atrial ablation, biatrial ablation was more effective in restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.
BACKGROUND: The purpose of this study was to compare the clinical and rhythm outcomes between left atrial ablation and biatrial ablation in patients with atrial fibrillation-associated mitral valve diseases. METHODS: Data were collected on 284 patients who underwent left atrial ablation (n = 85) or biatrial ablation (n = 199) of atrial fibrillation using a cryoablation system combined with mitral operation from 2006 through 2009. Outcomes were compared using a propensity score study design based on 20 baseline patient characteristics. RESULTS: In baseline characteristics, patients in the biatrial group were more likely to have higher risk clinical and echocardiographic profiles than patients in the left atrial group. There were 2 early deaths (0.7%), 1 in each group, and 5 cases of permanent pacemaker implantation (1.8%) only in the biatrial group. Follow-up was complete in 95.1% (n = 270). During a mean follow-up duration of 26.0 ± 13.3 months, there were 12 late deaths (1 in the left atrial group, 11 in the biatrial group). Cumulative incidence of atrial fibrillation in the absence of antiarrhythmic medications at 2 years was 25.9% ± 5.8% in the left atrial group and 14.3% ± 2.8% in the biatrial group (adjusted hazard ratio 3.06, 95% confidence interval: 1.41 to 6.66, p = 0.005). Major adverse events included stroke in 1, cardiac reoperation in 3, and anticoagulation-related hemorrhages in 16, infective endocarditis in 1, and mechanical valve thrombosis in 1, with no significant intergroup differences in major event-free survival rate (p = 0.73). CONCLUSIONS: Compared with left atrial ablation, biatrial ablation was more effective in restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.
Authors: Lori K Soni; Sophia R Cedola; Jacob Cogan; Jeffrey Jiang; Jonathan Yang; Hiroo Takayama; Michael Argenziano Journal: J Thorac Cardiovasc Surg Date: 2013-02 Impact factor: 5.209