Document Detail

The association between early atrial arrhythmia and long-term return to sinus rhythm for patients following the Cox maze procedure for atrial fibrillation.
MedLine Citation:
PMID:  23329227     Owner:  NLM     Status:  Publisher    
OBJECTIVES: Observational studies identified increased age, left atrial (LA) size, type and duration of atrial fibrillation (AF) as independent predictors for failure of AF surgical ablation. Rhythm at discharge following the Cox maze (CM) procedure for AF was never considered a significant predictor of success. The purposes of this study were to: (i) Determine the association of sinus rhythm (SR) at discharge and maintenance of SR. (ii) Identify the variables associated with discharge rhythm. (iii) Identify the effects of discharge rhythm on health-related quality of life (HRQL) post-CM procedure. METHODS: A prospective study (n = 534) of CM III/IV patients. Rhythm captured during hospitalization, discharge, 3, 6, 12 and 24 months and verified by electrocardiogram and 24-h holter. Subsequent SR interventions were captured. Logistic regression identified predictors of discharge rhythm. HRQL (Short-Form 12; AF symptom frequency and Severity Checklist V3) obtained during follow-up. RESULTS: Eighty-eight percent were discharged in SR (n = 469). LA size (OR = 1.36, CI: 1.02-1.82, P = 0.035) and long-standing AF type (OR = 2.68, CI: 1.31-5.50, P = 0.007) were the only independent predictors of non-SR at discharge. Lower rates of SR at 2 years were found in patients discharged in non-SR (75 vs 91%, P = 0.01). Patients discharged in SR had fewer perioperative morbidities [prolonged ventilation >24 h (6 vs 14%, P = 0.03), renal failure requiring dialysis (0.9 vs 5%, 0.04) and pneumonia (2 vs 9%, P = 0.005)]. During follow-up (mean = 43 ± 27 months), patients discharged in SR had fewer cardioversions (15 vs 29%, P = 0.006), similar percutaneous catheter ablations (6 vs 5%, P = 1.00) and no difference in late embolic strokes (1.5 vs 1.1%, P = 0.54). CONCLUSIONS: In this large prospective cohort study, rhythm at discharge was found to be clinically significant with predicting SR at 24 months. Surgeons should be aware that the prognosis of non-SR patients at discharge remains excellent with high rates of SR at 24 months if managed appropriately using rhythm rather than rate control strategies.
Niv Ad; Linda Henry; Sari D Holmes; Lori E Stone; Sharon Hunt
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-17
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Inova Heart and Vascular Institute, Falls Church, VA, USA.
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