Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR
<i>Background and Objectives</i>: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in t...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/11/1607 |
| _version_ | 1797467309420314624 |
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| author | Yalin Yildirim Johannes Petersen Ali Aydin Yousuf Alassar Hermann Reichenspurner Simon Pecha |
| author_facet | Yalin Yildirim Johannes Petersen Ali Aydin Yousuf Alassar Hermann Reichenspurner Simon Pecha |
| author_sort | Yalin Yildirim |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in those patients. We investigated the outcome of patients with isolated pulmonary vein isolation compared to those receiving an extended left atrial (LA) lesion set. <i>Materials and Methods</i>: Between 2003 and 2016, 817 patients received concomitant surgical AF ablation in our institution. A total of 268 patients with paroxysmal AF were treated by surgical ablation concomitant to AVR or CABG. Of those, 86 patients underwent a complete left-sided lesion set, while 182 patients were treated with an isolated pulmonary vein isolation. The primary endpoint was freedom from atrial fibrillation at 12 months’ follow-up. <i>Results:</i> There were no statistically significant differences regarding baseline characteristics. No major ablation-related complications were observed in any of the groups. In the PVI group, three patients (1.6%) had an intraoperative stroke, while two (2.3%) patients experienced a stroke in the LA ablation group (<i>p</i> = 0.98). In-hospital mortality was 3.4% in the PVI group, and 2.8% in the extended LA group (<i>p</i> = 0.33). Freedom from AF at 12 months’ follow-up was 76% in the extended LA ablation group and 70% in the PVI group, showing no statistically significant difference (<i>p</i> = 0.32). <i>Conclusion:</i> Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is safe and effective. There was no statistically significant difference between the compared lesion sets in terms of freedom from AF, survival or stroke rate after 12 months. |
| first_indexed | 2024-03-09T18:51:47Z |
| format | Article |
| id | doaj.art-4ffdb9c056674203a0f88c4d66578206 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T18:51:47Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-4ffdb9c056674203a0f88c4d665782062023-11-24T05:47:34ZengMDPI AGMedicina1010-660X1648-91442022-11-015811160710.3390/medicina58111607Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVRYalin Yildirim0Johannes Petersen1Ali Aydin2Yousuf Alassar3Hermann Reichenspurner4Simon Pecha5Department of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, GermanyHeart Center Bremen-Kardiologic-Angiologic Practice (KAP) Bremen, 28277 Bremen, GermanyDepartment of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, GermanyDepartment of Cardiovascular Surgery, University Heart Center Hamburg, 20246 Hamburg, Germany<i>Background and Objectives</i>: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in those patients. We investigated the outcome of patients with isolated pulmonary vein isolation compared to those receiving an extended left atrial (LA) lesion set. <i>Materials and Methods</i>: Between 2003 and 2016, 817 patients received concomitant surgical AF ablation in our institution. A total of 268 patients with paroxysmal AF were treated by surgical ablation concomitant to AVR or CABG. Of those, 86 patients underwent a complete left-sided lesion set, while 182 patients were treated with an isolated pulmonary vein isolation. The primary endpoint was freedom from atrial fibrillation at 12 months’ follow-up. <i>Results:</i> There were no statistically significant differences regarding baseline characteristics. No major ablation-related complications were observed in any of the groups. In the PVI group, three patients (1.6%) had an intraoperative stroke, while two (2.3%) patients experienced a stroke in the LA ablation group (<i>p</i> = 0.98). In-hospital mortality was 3.4% in the PVI group, and 2.8% in the extended LA group (<i>p</i> = 0.33). Freedom from AF at 12 months’ follow-up was 76% in the extended LA ablation group and 70% in the PVI group, showing no statistically significant difference (<i>p</i> = 0.32). <i>Conclusion:</i> Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is safe and effective. There was no statistically significant difference between the compared lesion sets in terms of freedom from AF, survival or stroke rate after 12 months.https://www.mdpi.com/1648-9144/58/11/1607atrial fibrillationsurgical ablationarrhythmia surgerypulmonary vein isolationleft-atrial ablation |
| spellingShingle | Yalin Yildirim Johannes Petersen Ali Aydin Yousuf Alassar Hermann Reichenspurner Simon Pecha Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR Medicina atrial fibrillation surgical ablation arrhythmia surgery pulmonary vein isolation left-atrial ablation |
| title | Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR |
| title_full | Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR |
| title_fullStr | Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR |
| title_full_unstemmed | Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR |
| title_short | Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR |
| title_sort | complete left atrial lesion set versus pulmonary vein isolation only in patients with paroxysmal af undergoing cabg or avr |
| topic | atrial fibrillation surgical ablation arrhythmia surgery pulmonary vein isolation left-atrial ablation |
| url | https://www.mdpi.com/1648-9144/58/11/1607 |
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