Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting

OBJECTIVES Left atrial (LA) dimension can predict atrial fibrillation (AF) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding pat...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 2015-11, Vol.48 (5), p.765-777
Main Authors: Kainuma, Satoshi, Mitsuno, Masataka, Toda, Koichi, Funatsu, Toshihiro, Nakamura, Teruya, Miyagawa, Shigeru, Yoshikawa, Yasushi, Fukushima, Satsuki, Yoshioka, Daisuke, Saito, Tetsuya, Nishi, Hiroyuki, Takahashi, Toshiki, Sakaki, Masayuki, Monta, Osamu, Matsue, Hajime, Masai, Takafumi, Sakaguchi, Taichi, Yoshitaka, Hidenori, Ueno, Takayoshi, Kuratani, Toru, Daimon, Takashi, Taniguchi, Kazuhiro, Miyamoto, Yuji, Sawa, Yoshiki
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Atrial Fibrillation - etiology
Coronary Artery Bypass - adverse effects
Female
Heart Atria - physiopathology
Heart Valve Prosthesis Implantation - adverse effects
Humans
Male
Middle Aged
Pulmonary Veins - surgery
Retrospective Studies
ROC Curve
Treatment Outcome
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Summary:OBJECTIVES Left atrial (LA) dimension can predict atrial fibrillation (AF) recurrence after catheter-based or surgical ablation. Pulmonary vein isolation (PVI) may be a surgical option during aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG), though consensus regarding patient selection and late outcome is lacking. METHODS We studied 160 patients (mean age 70 ± 9 years) with paroxysmal AF who underwent radiofrequency-based PVI during AVR and/or CABG, and were followed up postoperatively for at least 6 months. Mean preoperative LA dimension was 44 ± 7 mm. Serial echocardiography was performed to evaluate left ventricular (LV) and LA dimensions, E/e′, estimated systolic pulmonary artery (PA) pressure and degree of valvular regurgitation. Follow-up was completed with a mean duration of 47 ± 25 months. RESULTS At the latest follow-up, 133 patients (83%) remained in sinus rhythm. Preoperative LA dimension was independently associated with increased risk of AF recurrence at 6 months after surgery [adjusted odds ratio 1.3 per 1-mm increase in LA dimension, 95% confidence interval (CI) 1.1–1.6, P < 0.001]. Receiver-operating characteristic curve analysis demonstrated an optimal cut-off value for preoperative LA dimension of 45 mm to predict sinus rhythm restoration (98% for
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezu532