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Background:Mitral valve pathology is frequently associated with auricular dilatation and atrial fibrillation. Mitral surgery allows an immediate surgical auricular remodeling and besides in those cases in which sinus rhythm is reached, it is followed by a late remodeling. The aim of this study is to investigate the process of postoperative auricular remodeling in patients with permanent atrial fibrillation undergoing mitral surgery.Methods:In a prospective randomized trial, 50 patients with permanent atrial fibrillation and dilated left atrium, submitted to surgical mitral repair, were divided into two groups: Group I contained 25 patients with left auricular reduction and mitral surgery, and Group II contained 25 patients with isolated valve surgery. Both groups were considered homogeneous in the preoperative assessment.Results:After a mean follow-up of 31 months, 46% of patients included in Group I versus 18% of patients included in Group II restarted sinus rhythm (p= 0.06). An auricular remodeling with size regression occurred in those patients who recovered from sinus rhythm, worthy of remark in Group II (–10.8% of left auricular volume reduction in Group I compared to–21.5% in Group II; p<0.05). A new atrial enlargement took place in those patients who remained with atrial fibrillation (+16.8% left auricular volume in Group I vs.+8.4% in Group II; p<0.05).Conclusions:Mitral surgery produces an atrial postoperative volume that decrease especially when reduction techniques are employed. Late left atrial remodeling depended on the type of atrial rhythm and postoperative surgical volume.(J Card Surg 2004;19:376-382) [ABSTRACT FROM AUTHOR]

Background:The maze procedure can be performed surgically with radiofrequency, generating transmural ablation lines. We report our experience with a biatrial pattern of lesions based on the use of epicardial and endocardial radiofrequency ablation in an effort to minimize maze procedure.Method:In 85 patients undergoing cardiac surgery for established permanent atrial fibrillation (>3 months), a biauricular pattern of epicardic–endocardic maze lesions was performed. The main surgical procedures were diverse: 42 mitral valve surgeries, 7 mitrotricuspid valves, 18 mitroaortics, 4 mitroaortic and tricuspids, 2 aortic valves, 3 CABGs, 5 CABG and valve procedures, and 4 atrial septal defects. The mean age of the patients was 61± 12 (range 39–78). The mean duration of atrial fibrillation was 5.8 years (range 0.3 to 24).Results:Sixty-two (72.9%) patients presented postoperative supraventricular arrhythmia. Hospital mortality was seen in five patients (5.8%). Two patients died after a 12-month mean follow-up (range 2 to 32). A total of 14.1% of patients remained with their previous atrial fibrillation and 85.9% recovered and maintained sinus rhythm, with two patients having a permanent pacemaker. A total of 56% patients have been followed-up for a period of more than 6 months, and among them prevalence of sinus rhythm is 87.5%. Echocardiography detected biauricular contraction in 65% of them. After analyzing the data, factors involved in postoperative recurrence of atrial fibrillation after radiofrequency surgery were oldness of the atrial fibrillation (p<0.01) and pre and postoperative left auricle volume (p<0.04).Conclusion:Intraoperative radiofrequency has permitted us to perform the maze procedure in a simple way, with a low surgical morbid-mortality. We have obtained an 85.9% electrographic effectiveness and a 65% recovery of atrial contraction. Postoperative incidence of arrhythmia is the main postoperative problem.(J Card Surg 2004;19:383-388) [ABSTRACT FROM AUTHOR]