Surgery for atrial fibrillation

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

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective. The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. Methods. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. Results. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 77%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P <0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P <0.001). Restoration of the right atrial function raised the cardiac index from 2.25 ± 0.55 l/min per m 2 during atrial fibrillation to 2.54 ± 0.58 l/min per m 2, with a mean percentage increase in cardiac index of 13.5% (P <0.00018). Atrial partitioning ("maze operation") was performed on five patients with an immediate sinus rhythm recovery of 100%, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5%), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications 2-52 months after operation. Thirteen of 14 patients with "lone" atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92%. Conclusions. Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.

Original languageEnglish
Pages (from-to)490-497
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume10
Issue number7
Publication statusPublished - 1996

Fingerprint

Atrial Fibrillation
Mitral Valve
Heart Atria
Atrial Heart Septal Defects
Right Atrial Function
Heart Ventricles
Tricuspid Valve
Patient Rights
Heart Diseases

Keywords

  • Atrial fibrillation
  • Atrial isolation
  • Corridor procedure
  • Cryoablation
  • Maze operation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Vigano&apos;, M., Graffigna, A., Ressia, L., Minzioni, G., Pagani, F., Aiello, M., & Gazzoli, F. (1996). Surgery for atrial fibrillation. European Journal of Cardio-thoracic Surgery, 10(7), 490-497.

Surgery for atrial fibrillation. / Vigano&apos;, M.; Graffigna, A.; Ressia, L.; Minzioni, G.; Pagani, F.; Aiello, M.; Gazzoli, F.

In: European Journal of Cardio-thoracic Surgery, Vol. 10, No. 7, 1996, p. 490-497.

Research output: Contribution to journalArticle

Vigano&apos;, M, Graffigna, A, Ressia, L, Minzioni, G, Pagani, F, Aiello, M & Gazzoli, F 1996, 'Surgery for atrial fibrillation', European Journal of Cardio-thoracic Surgery, vol. 10, no. 7, pp. 490-497.
Vigano&apos; M, Graffigna A, Ressia L, Minzioni G, Pagani F, Aiello M et al. Surgery for atrial fibrillation. European Journal of Cardio-thoracic Surgery. 1996;10(7):490-497.
Vigano&apos;, M. ; Graffigna, A. ; Ressia, L. ; Minzioni, G. ; Pagani, F. ; Aiello, M. ; Gazzoli, F. / Surgery for atrial fibrillation. In: European Journal of Cardio-thoracic Surgery. 1996 ; Vol. 10, No. 7. pp. 490-497.
@article{3af53963625c4dc2aaaf012fb56ead2a,
title = "Surgery for atrial fibrillation",
abstract = "Objective. The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. Methods. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ({"}maze operation{"}) creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. {"}Lone{"} atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal {"}corridor{"} was performed on 14 patients. Results. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 77{\%}. In the same period, sinus rhythm was recovered and persisted in only 19{\%} of 252 patients who underwent mitral valve replacement along (P <0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59{\%} vs 84{\%} (P <0.001). Restoration of the right atrial function raised the cardiac index from 2.25 ± 0.55 l/min per m 2 during atrial fibrillation to 2.54 ± 0.58 l/min per m 2, with a mean percentage increase in cardiac index of 13.5{\%} (P <0.00018). Atrial partitioning ({"}maze operation{"}) was performed on five patients with an immediate sinus rhythm recovery of 100{\%}, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5{\%}), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications 2-52 months after operation. Thirteen of 14 patients with {"}lone{"} atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92{\%}. Conclusions. Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.",
keywords = "Atrial fibrillation, Atrial isolation, Corridor procedure, Cryoablation, Maze operation",
author = "M. Vigano&apos; and A. Graffigna and L. Ressia and G. Minzioni and F. Pagani and M. Aiello and F. Gazzoli",
year = "1996",
language = "English",
volume = "10",
pages = "490--497",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "7",

}

TY - JOUR

T1 - Surgery for atrial fibrillation

AU - Vigano&apos;, M.

AU - Graffigna, A.

AU - Ressia, L.

AU - Minzioni, G.

AU - Pagani, F.

AU - Aiello, M.

AU - Gazzoli, F.

PY - 1996

Y1 - 1996

N2 - Objective. The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. Methods. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. Results. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 77%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P <0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P <0.001). Restoration of the right atrial function raised the cardiac index from 2.25 ± 0.55 l/min per m 2 during atrial fibrillation to 2.54 ± 0.58 l/min per m 2, with a mean percentage increase in cardiac index of 13.5% (P <0.00018). Atrial partitioning ("maze operation") was performed on five patients with an immediate sinus rhythm recovery of 100%, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5%), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications 2-52 months after operation. Thirteen of 14 patients with "lone" atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92%. Conclusions. Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.

AB - Objective. The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. Methods. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. Results. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 77%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P <0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P <0.001). Restoration of the right atrial function raised the cardiac index from 2.25 ± 0.55 l/min per m 2 during atrial fibrillation to 2.54 ± 0.58 l/min per m 2, with a mean percentage increase in cardiac index of 13.5% (P <0.00018). Atrial partitioning ("maze operation") was performed on five patients with an immediate sinus rhythm recovery of 100%, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5%), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications 2-52 months after operation. Thirteen of 14 patients with "lone" atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92%. Conclusions. Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.

KW - Atrial fibrillation

KW - Atrial isolation

KW - Corridor procedure

KW - Cryoablation

KW - Maze operation

UR - http://www.scopus.com/inward/record.url?scp=0030329782&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030329782&partnerID=8YFLogxK

M3 - Article

C2 - 8855419

AN - SCOPUS:0030329782

VL - 10

SP - 490

EP - 497

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 7

ER -