Dataset Information

Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes.

ABSTRACT:

Objective

We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied.

Study design and setting

SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery.

Results

Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m2; 95% confidence interval (CI): 1.0206-1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002].

Conclusions

In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.

SUBMITTER: Kim D

PROVIDER: S-EPMC6135507 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes.

Kim Darae D Shim Chi Young CY Hong Geu-Ru GR Cho In Jeong IJ Lee Seung Hyun SH Chang Hyuk-Jae HJ Lee Sak S Ha Jong-Won JW Chang Byung-Chul BC

PloS one 20180912 9

<h4>Objective</h4>We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied.<h4>Study design and setting</h4>SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after s ...[more]

PMID: 30208099

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Project description:BackgroundAmong patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited.MethodsWe randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring).ResultsMore patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions.ConclusionsThe addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.).

Project description:BackgroundThe incidence of permanent pacemaker (PPM) implantation is higher following mitral valve surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone.ObjectivesThis study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS.MethodsA total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality.ResultsThirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multivalve surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class.ConclusionsAF ablation, multivalve surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370).

Dataset Information

Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes.

Objective

Study design and setting

Results

Conclusions

Publications

Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes.

Similar Datasets

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