Anders Jönsson1, Mika Lehto2, Henrik Ahn3, Ulf Hermansson3, Peter Linde4, Anders Ahlsson5, Juhani Koistinen6, Jukka Savola7, Pekka Raatikainen8, Martti Lepojärvi9, Antero Sahlman10, Kalervo Werkkala10, Lauri Toivonen2, Håkan Walfridsson1. 1. Department of Cardiology, Linnköping University Hospital, Linnköping, Sweden. 2. Department of Cardiology, Helsinki University Hospital, Helsinki, Finland. 3. Department of Cardiothoracic Surgery, Linnköping University Hospital, Linnköping, Sweden. 4. Department of Cardiology, Örebro University Hospital, Örebro, Sweden. 5. Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden. 6. Department of Cardiology, Turku University Hospital, Turku, Finland. 7. Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland. 8. Heart Center, Tampere University Hospital, Tampere, Finland. 9. Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland. 10. Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland.
Abstract
Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy. Methods:70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22). Conclusion:Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.
RCT Entities:
Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy. Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22). Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.
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