Left atrial isolation for the treatment of atrial fibrillation due to mitral valve disease. Hemodynamic evaluation

A. Graffigna, L. Ressia, F. Pagani, G. Minzioni, M. Vigano

Research output: Contribution to journalArticle

Abstract

Ablation of atrial fibrillation secondary to mitral valve disease is frequently impossible after isolated mitral valve surgery. In order to improve sinus rhythm recovery in such patients, patients with rheumatic mitral valve disease and chronic atrial fibrillation underwent surgical electrophysiological isolation of the left atrium at the time of surgery. The left atrium is left free to fibrillate, beat or stand still, while the right atrium recovers its sinus activation and warrants a regular ventricular rate. Apart from this advantage, we tested the hypothesis that the recovery of right atrial 'booster' function could significantly improve cardiac output. From May 1989 to July 1993 184 patients with mitral with or without other valve disease underwent this procedure. There were 8 (4.3%) operative deaths (3 for LOS, 3 for ARDS, 2 for MOF) and 7 (3.8%) late deaths (sudden or unexplained deaths in 4 cases, lung cancer, prosthetic failure, pneumonia in 1 pt each). Immediate recovery of sinus rhythm was achieved in 142 pts (78.1%) and persistence was found in 131 (71%). A personal experience shows that sinus rhythm was restored and maintained in only 19% of 100 patients after valvular surgery alone. In fourteen patients cardiac output was measured under high rate right atrial pacing vanishing right atrial function and variable ventricular rate like in atrial fibrillation, right atrial pacing at similar rate like in left atrial isolation, and right and left atrial pacing (when possible) like in normal sinus rhythm. Cardiac output increased from a mean 2.25 L/m'/m'' in atrial fibrillation to a mean of 2.54 L/m'/m'' in 'left atrial isolation' (p <0.00018) and to a mean of 2.7 L/m'/m'' in 'sinus rhythm' (p = N.S.). A mean percentage increase of 13.5% was obtained with left atrial isolation. Results indicate that left atrial isolation definitely improves the probability of recovery of sinus rhythm and that increases cardiac performance in comparison with atrial fibrillation.

Original languageEnglish
Pages (from-to)1069-1075
Number of pages7
JournalNew Trends in Arrhythmias
Volume9
Issue number4
Publication statusPublished - 1993

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Keywords

  • atrial fibrillation
  • left atrial isolation
  • mitral valve disease
  • mitral valve surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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