Abstract 13278: Surgical Ablation of Atrial Fibrillation in Patients with Giant Left Atrium
Background: As the efficacy of surgical ablation in the elimination of atrial fibrillation (AF) has been reported suboptimal in patients with giant left atrium (LA), its routine performance on this cohort has been debated.
Methods: By reviewing our institutional database, we identified 759 patients (mean age, 55.3 years; 415 females) undergoing mitral valve (MV) surgery in the presence of giant LA (>60mm) and AF from 1999 through 2012. Of these, 400 underwent concomitant AF ablation (Maze group), whereas AF was left untreated surgically in the remaining 359 patients (No-Maze group). To reduce the impact of selection bias, propensity score analyses was performed based on 25 baseline covariates.
Results: Median follow-up period was 90.0 months (Quartile 1-3, 43.6-124.2 months). Freedom from postoperative AF recurrence at 5 years was 65.0% in the Maze group and 8.6% in the No-Maze group (P<0.001). After adjustment, the Maze group showed significantly lower risks of death (HR, 0.65; 95% CI, 0.44-0.98; P=0.038), thromboembolic events (HR, 0.23; 95% CI, 0.09-0.58; P=0.002) and the composite of adverse outcomes (death, heart failure and valve-related complications; HR, 0.55; 95% CI 0.42-0.71; P<0.001) compared with the No-Maze group. In subgroup analyses, AF ablation showed superior survival and event-free survival in most subgroups compared to surgeries without AF ablation (Figure). On long-term echocardiographic assessment (n=651; median follow-up, 59.4 months; quartile 1-3, 23.9-85.5 months), the Maze group showed superior left ventricle ejection fraction (58.5% vs. 55.3%; P<0.001) and tricuspid function (tricuspid regurgitation ≥ moderate: 10.1% vs. 19.6%, P<0.001) compared with the No-Maze group.
Conclusions: Concomitant AF surgical ablation improved postoperative rhythm status, clinical outcomes and cardiac function in patients with giant LA undergoing MV surgery. Our study findings strongly suggest combining AF ablation even in patients with giant LA.
Author Disclosures: H. Kim: None. J. Kim: None. S. Jung: None. S. Choo: None. C. Chung: None. J. Lee: None.
- © 2014 by American Heart Association, Inc.