Aortic Valve Disease, Atrial Fibrillation, Coronary Artery Disease, Mitral Valve Disease, Tricuspid Valve Disease
Conditions
Keywords
Atrial Fibrillation, Left Atrial Cryoablation, Ganglionated Plexi, Open-Heart Surgery
Brief summary
The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery.
Detailed description
The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, thirty-five of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with decision and ablation of the ligament of Marshall.
Interventions
PROCEDUREConcomitant Mapping and Radiofrequency Ablation
Mapping of GP around the orifice of pulmonary veins was performed, together with their radiofrequency ablation. In the area of right-side pulmonary veins, the procedure was performed prior to initiation of extracorporeal circulation. In case of the left-side PVs; the procedure was performed after initiation of extracorporeal circulation. Part of this procedure was also a decision and ablation of the ligament of Marshall. GP mapping was performed using high-frequency stimulation (1000 beats min-¹, potential 18V, pulse width 1.5ms). The indication for GP ablation was a doubling in the R-R interval in the sinus rhythm, or ventricular rate slowing of more that 50% associated with a decrease of blood pressure\>20mmHg in patients with AF. In case of a positive response, radiofrequency ablation of the ganglia was performed following switching of the pen at the console. This procedure was repeated until the activity of the ganglia has disappeared.
PROCEDURENo intervention
No intervention was performed in patients without ganglionated plexi.
Sponsors
University Hospital Ostrava
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Two groups of patients undergoing standard treatment have been compared retrospectively.
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Indication for open-heart surgery (mitral valve disease and/or tricuspidal valve disease and/or aortic valve disease and/or coronary artery disease and/or other) * Concomitant paroxysmal, persistent, long standing persistent atrial fibrillation * Signing of the informed consent
Exclusion criteria
* Age below 40 and over 80 years of age * Left ventricular ejection fraction below 25% * Left atrium diameter over 60mm * Permanent atrial fibrillation * Polymorbidity (Euroscore II over 10) * Emergency surgery * Renal insufficiency (creatinine over 200 umol/l)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sinus Rhythm | 30 months | The primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence of Atrial Fibrillation and the Presence of a Mitral Valve Surgery | 30 months | The secondary outcome was the detection of relationship between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, the presence of a mitral and tricuspid valves surgery and the left atrium diameter \>50 mm. |
Outcome results
None listed