Surgical ablation of atrial fibrillation during mitral-valve surgery.
Publication/Presentation Date
4-9-2015
Abstract
BACKGROUND: Among 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.
METHODS: We 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).
RESULTS: More 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
CONCLUSIONS: The 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.).
Volume
372
Issue
15
First Page
1399
Last Page
1409
ISSN
1533-4406
Published In/Presented At
Gillinov, A. M., Gelijns, A. C., Parides, M. K., DeRose, J. J., Jr, Moskowitz, A. J., Voisine, P., Ailawadi, G., Bouchard, D., Smith, P. K., Mack, M. J., Acker, M. A., Mullen, J. C., Rose, E. A., Chang, H. L., Puskas, J. D., Couderc, J. P., Gardner, T. J., Varghese, R., Horvath, K. A., Bolling, S. F., … CTSN Investigators (2015). Surgical ablation of atrial fibrillation during mitral-valve surgery. The New England journal of medicine, 372(15), 1399–1409. https://doi.org/10.1056/NEJMoa1500528
Disciplines
Medicine and Health Sciences
PubMedID
25853744
Department(s)
Department of Surgery
Document Type
Article