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Medium-term outcome of different surgical methods to cure atrial fibrillation: is less worse?

^a Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
^b Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
^c Department of Cardiology, University of Utrecht, The Netherlands

*Corresponding author. Koekoekslaan 1, 3430 EM Nieuwegein, The Netherlands. Tel.: +31-306099111; fax: +31-306092120.

E-mail address: G.S.C.Geuzebroek{at}gmail.com (G.S.C. Geuzebroek).

Different lesion sets and ablation techniques have been performed. We compared these outcomes in search of the best method. We performed a retrospective analysis of patients who have undergone AF surgery different from the maze III. The surgical lesion sets were pulmonary vein isolation (PVI) alone, left atrial maze (LAM) and bi-atrial maze (BAM) and were made with different ablation techniques. During surgery one patient died due to bleeding of a pulmonary vein. The number of patients in the PVI-, LAM-, BAM-groups was 12, 28 and 26, respectively, with freedom from AF at latest follow-up [22.0±15.6 (3.1–81.2) months] of 33%, 59% and 60%, respectively. Atrial flutter occurred less in the BAM-group (4%) than in the left-sided procedures (15.4%) (P=0.231). Multivariate analysis demonstrated a higher recurrence of AF for PVI alone (OR 4.42, CL 0.95–20.6, P=0.0583) and a lower recurrence for the ‘cut-and-sew’ technique (OR 0.13, CL 0.030–0.60, P=0.0084). Left- and bi-atrial maze procedures are equally effective in the suppression of AF, whereas omission of right-sided lesions results in a higher prevalence of atrial flutter. The ‘cut-and-sew’ technique is superior in terms of freedom from AF compared to bipolar and unipolar radiofrequency.

Key Words: Atrial fibrillation; Rhythm surgery; Maze; Arrhythmia

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eComment: Bilateral atrial appendage excision should be performed routinely in the surgical treatment of atrial fibrillation

Bachar El Oumeiri, Parla Astarci, and Valérie Lacroix
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				B. E. Oumeiri, P. Astarci, and V. Lacroix eComment: Bilateral atrial appendage excision should be performed routinely in the surgical treatment of atrial fibrillation Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 205 - 206. [Full Text] [PDF]