| Percutaneous catheter ablation treatment of recurring atrial arrhythmias after surgical ablation. | |
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MedLine Citation:
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PMID: 20338340 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Surgical ablation for atrial fibrillation is associated with early and late recurrence of atrial arrhythmias. Although early arrhythmias may be controlled with conventional treatment, late arrhythmias are often highly symptomatic and relatively hard to manage with antiarrhythmic drugs and electrical cardioversion. This study explores a single-center experience with catheter ablation to treat late failures (>3 months) after surgery. METHODS: This is a prospective longitudinally designed study assessing all patients who underwent surgical treatment for atrial fibrillation as a standalone or concomitant with other procedures by multiple surgeons. All patients were monitored according to the Heart Rhythm Society guidelines. RESULTS: From January 2005 to present, 400 consecutive patients operated on by multiple surgeons were enrolled. The overall success rate per the Heart Rhythm Society guidelines was 87% and 84% (off antiarrhythmic drugs, 78% and 73%) at 12 and 24 months, respectively. Sixteen patients (4%) were referred for electrophysiology study after the surgical procedure (15 Cox-maze III or IV, 1 pulmonary vein isolation). The average age was 61.1+/-15.2 years; the mean left atrium size was 5.1+/-0.7 cm; and the mean time to ablation was 16.9+/-10 months. In 16 patients radiofrequency ablation was applied to treat the following atrial arrhythmias: 7 right atrial flutter or tachycardia, 3 left atrial flutter, 1 biatrial flutter, and 5 left atrial tachycardia. Six patients required a subsequent radiofrequency ablation intervention including 4 patients who required atrioventricular nodal ablations. The long-term success rate for the subsequent catheter ablation in these 16 patients (follow-up of 42.9+/-9.8 months) determined by the rate of sinus rhythm as captured by electrocardiography was 94%. Fifty-three percent of the patients (n=8) in sinus rhythm were still taking antiarrhythmic drugs; 8 patients remained on warfarin. There was 1 late noncardiac death and no late strokes. CONCLUSIONS: In a certain subset of patients, unsuccessful surgical ablation of atrial fibrillation may result in symptomatic atrial arrhythmia. If indicated, catheter ablation is a safe and effective intervention with a relatively high success rate. The combination of the two treatment modalities, catheter and surgical ablation, can improve the outcome even in complex patients. |
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Authors:
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Linda Henry; Sarfraz Durrani; Sharon Hunt; Ted Friehling; Henry Tran; Marc Wish; Albert Del Negro; Margaret Bell; Niv Ad |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 89 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-26 Completed Date: 2010-04-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1227-31; discussion 1231-2 Citation Subset: AIM; IM |
Copyright Information:
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Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Inova Heart and Vascular Institute, Falls Church, Virginia 22042, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arrhythmias, Cardiac
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surgery* Atrial Fibrillation / surgery* Catheter Ablation* / methods Heart Atria* Humans Middle Aged Postoperative Complications / surgery* Prospective Studies Recurrence |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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