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Long-term results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation.

Zheng S, Li Y, Han J, Zhang H, Zeng W, Xu C, Jia Y, Wang J, Guo K, Jiao Y, Meng X - PLoS ONE (2013)

Bottom Line: Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively.Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively.Two patients underwent perioperative cerebrovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background: Ganglionated plexi (GP) ablation has been become an adjunct to pulmonary vein isolation (PVI). This study describes the long-term results of minimally invasive surgical PVI, ablation of GPs, and exclusion of the left atrial appendage for atrial fibrillation (AF).

Methods: Long-term follow-up of 55 months was performed in 139 consecutive patients (age 58.3±20.8 years) with symptomatic, drug-refractory lone AF who underwent minimally invasive surgical PVI, GPs ablation, and exclusion of the left atrial appendage. Success was defined as freedom from AF, atrial flutter, or atrial tachycardia off antiarrhythmic drugs.

Results: AF was paroxysmal in 77.7%, persistent in 12.2% and long-standing persistent in 10.1%. Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively. Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively. Duration of AF>24 months (hazard ratio [HR]: 3.09, 95% confidence interval [CI]: 1.51 to 6.32; p = 0.002), left atrial diameter≥40 mm (HR: 4.03, 95% CI: 1.88 to 8.65; p<0.001), early recurrence of AF (HR: 4.66, 95% CI: 2.25 to 9.63; p<0.001) independently predicted long-term recurrence of AF. There was no procedure-related death. One patient converted to median sternotomy because of uncontrolled bleeding. Two patients underwent perioperative cerebrovascular events.

Conclusions: At nearly 5-year of clinical follow-up, single-procedure success rate of minimally invasive surgical PVI with GP ablation was 51.8% for paroxysmal AF, 28.2% for persistent AF, 28.6% for long-standing persistent AF after initial procedure. Patients with AF duration≤24 months, left atrial diameter<40 mm and no early recurrence of AF, had favorable outcomes.

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Single-procedure success for patients with LA diameter<40 mm versus≥40 mm (A), with AF duration≤24 months versus>24 months (B), with ERAF versus without ERAF (C).Plus sign (+) indicates censored.
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pone-0079755-g002: Single-procedure success for patients with LA diameter<40 mm versus≥40 mm (A), with AF duration≤24 months versus>24 months (B), with ERAF versus without ERAF (C).Plus sign (+) indicates censored.

Mentions: Univariate predictors of long-term recurrent AF are duration of AF, LA diameter, ERAF and presence of AF at discharge (Table 4). Multivariate Cox regression analysis revealed that duration of AF, LA diameter, ERAF independently predicted recurrences of AF (Table 4). The ROC analyses further illustrated that the LA diameter and AF duration were the indicator of recurrent AF, with an AUC of 0.745 (p<0.001) and 0.76 (p<0.001) respectively. The cut-off of LA diameter and AF duration were 39.5 mm and 25 months respectively. Figure 2 show that patients with AF duration>24 months, LA diameter≥40 mm or ERAF has higher rate of recurrence of AF (All p<0.01). Fourteen patients had an AF duration≤24 months and LA diameter<40 mm and no ERAF, who had excellent rhythm outcome with single-procedure success rate of 100% at 60 months after surgery (p <0.001; Figure 3).


Long-term results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation.

Zheng S, Li Y, Han J, Zhang H, Zeng W, Xu C, Jia Y, Wang J, Guo K, Jiao Y, Meng X - PLoS ONE (2013)

Single-procedure success for patients with LA diameter<40 mm versus≥40 mm (A), with AF duration≤24 months versus>24 months (B), with ERAF versus without ERAF (C).Plus sign (+) indicates censored.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3823568&req=5

pone-0079755-g002: Single-procedure success for patients with LA diameter<40 mm versus≥40 mm (A), with AF duration≤24 months versus>24 months (B), with ERAF versus without ERAF (C).Plus sign (+) indicates censored.
Mentions: Univariate predictors of long-term recurrent AF are duration of AF, LA diameter, ERAF and presence of AF at discharge (Table 4). Multivariate Cox regression analysis revealed that duration of AF, LA diameter, ERAF independently predicted recurrences of AF (Table 4). The ROC analyses further illustrated that the LA diameter and AF duration were the indicator of recurrent AF, with an AUC of 0.745 (p<0.001) and 0.76 (p<0.001) respectively. The cut-off of LA diameter and AF duration were 39.5 mm and 25 months respectively. Figure 2 show that patients with AF duration>24 months, LA diameter≥40 mm or ERAF has higher rate of recurrence of AF (All p<0.01). Fourteen patients had an AF duration≤24 months and LA diameter<40 mm and no ERAF, who had excellent rhythm outcome with single-procedure success rate of 100% at 60 months after surgery (p <0.001; Figure 3).

Bottom Line: Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively.Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively.Two patients underwent perioperative cerebrovascular events.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background: Ganglionated plexi (GP) ablation has been become an adjunct to pulmonary vein isolation (PVI). This study describes the long-term results of minimally invasive surgical PVI, ablation of GPs, and exclusion of the left atrial appendage for atrial fibrillation (AF).

Methods: Long-term follow-up of 55 months was performed in 139 consecutive patients (age 58.3±20.8 years) with symptomatic, drug-refractory lone AF who underwent minimally invasive surgical PVI, GPs ablation, and exclusion of the left atrial appendage. Success was defined as freedom from AF, atrial flutter, or atrial tachycardia off antiarrhythmic drugs.

Results: AF was paroxysmal in 77.7%, persistent in 12.2% and long-standing persistent in 10.1%. Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively. Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively. Duration of AF>24 months (hazard ratio [HR]: 3.09, 95% confidence interval [CI]: 1.51 to 6.32; p = 0.002), left atrial diameter≥40 mm (HR: 4.03, 95% CI: 1.88 to 8.65; p<0.001), early recurrence of AF (HR: 4.66, 95% CI: 2.25 to 9.63; p<0.001) independently predicted long-term recurrence of AF. There was no procedure-related death. One patient converted to median sternotomy because of uncontrolled bleeding. Two patients underwent perioperative cerebrovascular events.

Conclusions: At nearly 5-year of clinical follow-up, single-procedure success rate of minimally invasive surgical PVI with GP ablation was 51.8% for paroxysmal AF, 28.2% for persistent AF, 28.6% for long-standing persistent AF after initial procedure. Patients with AF duration≤24 months, left atrial diameter<40 mm and no early recurrence of AF, had favorable outcomes.

Show MeSH
Related in: MedlinePlus