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Surgical treatment of atrial fibrillation using cryothermy in patients undergoing mitral valve surgery

Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, Mount Sinai Hospital, 1190 Fifth Avenue, Box 1028, New York, NY 10029-1028, USA

Corresponding author. Tel.: +1 212 659 6820; fax: +1 212 659 6818.

E-mail address: farzan.filsoufi{at}mountsinai.org (F. Filsoufi).

Surgical treatment of atrial fibrillation (AF) using a variety of energy sources and a mixture of lesion sets has become an important adjunct in patients undergoing cardiac surgery. We retrospectively analyzed prospectively collected data of 141 patients with a history of AF (mean duration of AF 35±39 months; intermittent AF: n=72; 51%; permanent AF: 69 (49%)) who underwent a left-sided Cryomaze procedure in conjunction with mitral valve (MV) surgery between January 2003 and September 2006. Freedom from AF was 77% at discharge and 87% at a mean follow-up of 305±195 days with a decreasing rate of AF during the first 3–9 months from 13% to 9% and an increase beyond the first year (29% at 2 years). Predictors of failed Cryomaze in multivariate analysis were left atrial size >50 mm (OR=5.7), AF at surgery (OR=5.0) and cardiac reoperation (OR=3.4), whereas preoperative beta-blocker treatment was a predictor of success (OR=0.2). Our data suggest that a left-sided Cryomaze procedure effectively restores sinus rhythm in patients with AF undergoing MV surgery. The success rate should not be evaluated immediately postoperatively because there is a steady increase in the rate of patients with freedom from AF in the first year. It appears, however, that there is a higher rate of recurrence during later follow-up.

Key Words: Atrial fibrillation; Maze procedure; Mitral valve surgery; Outcome

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