International journal of cardiology · 2015
Is ganglionated plexi ablation during Maze IV procedure beneficial for postoperative long-term stable sinus rhythm?
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gelsomino Sandro, Lozekoot Pieter, La Meir Mark, Lorusso Roberto, Lucà Fabiana, Rostagno Carlo, Renzulli Attilio, Parise Orlando, Matteucci Francesco, Gensini Gian Franco, Crjins Harry J G M, Maessen Jos G
Аннотация
BACKGROUND: We investigated the role of surgical ablation targeting the autonomous nervous system during a Cox-Maze IV procedure in the maintenance of sinus rhythm at long-term follow-up.
METHODS: The patient population consisted of 519 subjects with persistent or long-standing persistent atrial fibrillation (AF) undergoing radiofrequency Maze IV during open heart surgery between January 2006 and July 2013 at three institutions without (Group 1) or with (Group 2) ganglionated plexi (GP) ablation. Recurrence of atrial fibrillation off-antiarrhythmic drugs was the primary outcome. Predictors of AF recurrence were evaluated by means of competing risk regression. Median follow-up was 36.7 months.
RESULTS: The percentage of patients in normal sinus rhythm (NSR) off-antiarrhythmic drugs did not differ between groups (Group 1-75.5%, Group 2-67.8%, p = 0.08). Duration of AF ≥ 38 months (p = 0.01), left atrial diameter ≥ 54 mm (0.001), left atrial area ≥ 33 cm(2) (p = 0.005), absence of connecting lesions (p= 0.04), and absence of right atrial ablation (p < 0.001) were independently associated with high incidence of AF recurrence. In contrast the absence of GP ablation was not a significant factor (p = 0.12).
CONCLUSIONS: GP ablation did not prove to be beneficial for postoperative stable NSR. A complete left atrial lesion set and biatrial ablation are advisable for improving rhythm outcomes. Randomized controlled trials are necessary to confirm our findings.
METHODS: The patient population consisted of 519 subjects with persistent or long-standing persistent atrial fibrillation (AF) undergoing radiofrequency Maze IV during open heart surgery between January 2006 and July 2013 at three institutions without (Group 1) or with (Group 2) ganglionated plexi (GP) ablation. Recurrence of atrial fibrillation off-antiarrhythmic drugs was the primary outcome. Predictors of AF recurrence were evaluated by means of competing risk regression. Median follow-up was 36.7 months.
RESULTS: The percentage of patients in normal sinus rhythm (NSR) off-antiarrhythmic drugs did not differ between groups (Group 1-75.5%, Group 2-67.8%, p = 0.08). Duration of AF ≥ 38 months (p = 0.01), left atrial diameter ≥ 54 mm (0.001), left atrial area ≥ 33 cm(2) (p = 0.005), absence of connecting lesions (p= 0.04), and absence of right atrial ablation (p < 0.001) were independently associated with high incidence of AF recurrence. In contrast the absence of GP ablation was not a significant factor (p = 0.12).
CONCLUSIONS: GP ablation did not prove to be beneficial for postoperative stable NSR. A complete left atrial lesion set and biatrial ablation are advisable for improving rhythm outcomes. Randomized controlled trials are necessary to confirm our findings.