Abstract 12635: Surgical Treatment of Atrial Fibrillation: Effects of Different Techniques on Atrial Mechanical Function
Introduction: Multiple techniques exist for surgical treatment of atrial fibrillation (AF) including cut and sew (C&S), cryo and radiofrequency (RF) ablation. Restoration and maintenance of sinus rhythm, however, does not guarantee improved left atrial mechanical function (LAMF). We sought to determine the effect of surgical AF treatment technique on LAMF.
Methods: Echocardiograms were retrospectively reviewed for adult patients that underwent a left atrial surgical AF treatment between 2004 and 2010. Eligible patients had an echocardiogram in sinus rhythm or atrial paced rhythm preceding and > three months following surgery. Clinical, surgical, and echocardiographic variables were compared. LAMF was defined as: present (presence of A wave on mitral inflow and A’ on medial mitral annular tissue Doppler imaging), partial (either A or A’ present), or absent (neither A or A’ present). Active left atrial emptying fraction (LAEF) was determined by percent reduction in left atrial area from the onset of the P wave to mitral valve closure.
Results: Surgical treatment of AF ablation was performed in 132 patients (mean age 65.0 ± 11.3 years, 54 women) in the context of mitral valve surgery (56.8%), other valve surgery (45.4%), and coronary artery bypass grafting (24.2%). Techniques included: C&S alone (10.6%), RF (42.4%), cryo (30.3%) and mixed (16.7%). Biatrial treatment was performed in 37.1% and isolated pulmonary vein isolation (PVI) was performed in 44.7%. Pre- and post-operative LAMF results are shown (Table). LAMF decreased after surgical AF treatment. AF recurred in 13% of patients at median 37 months follow-up.
Conclusions: Surgical treatment of AF results in a decrease in LAMF particularly after C&S or cryoablation. Isolated PVI is less detrimental to LAMF than PVI with additional ablation. Whether or not the reduced LAMF results in deleterious clinical outcomes warrants further study.
- © 2013 by American Heart Association, Inc.