Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery

被引：332

作者：

Gillinov, A. Marc ^{[1
]}

Gelijns, Annetine C. ^{[2
]}

Parides, Michael K. ^{[2
]}

DeRose, Joseph J., Jr. ^{[3
]}

Moskowitz, Alan J. ^{[2
]}

Voisine, Pierre ^{[7
]}

Ailawadi, Gorav ^{[10
]}

Bouchard, Denis ^{[8
]}

Smith, Peter K. ^{[11
]}

Mack, Michael J. ^{[12
]}

Acker, Michael A. ^{[13
]}

Mullen, John C. ^{[9
]}

Rose, Eric A. ^{[4
]}

Chang, Helena L. ^{[2
]}

Puskas, John D. ^{[4
]}

Couderc, Jean-Philippe ^{[6
]}

Gardner, Timothy J. ^{[14
]}

Varghese, Robin ^{[4
]}

Horvath, Keith A. ^{[15
]}

Bolling, Steven F. ^{[18
]}

Michler, Robert E. ^{[3
]}

Geller, Nancy L. ^{[16
]}

Ascheim, Deborah D. ^{[2
]}

Miller, Marissa A. ^{[17
]}

Bagiella, Emilia ^{[2
]}

Moquete, Ellen G. ^{[2
]}

Williams, Paula ^{[2
]}

Taddei-Peters, Wendy C. ^{[17
]}

O'Gara, Patrick T. ^{[19
]}

Blackstone, Eugene H. ^{[1
]}

Argenziano, Michael ^{[5
]}

机构：

[1] Cleveland Clin Fdn, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44195 USA

[2] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Int Ctr Hlth Outcomes & Innovat Res, New York, NY 10029 USA

[3] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Cardiothorac Surg, New York, NY USA

[4] Mt Sinai Hlth Syst, Dept Cardiac Surg, New York, NY USA

[5] Columbia Univ Coll Phys & Surg, Dept Surg, Div Cardiothorac Surg, New York, NY 10032 USA

[6] Univ Rochester, Med Ctr, Dept Cardiol, Heart Res Follow Up Program, Rochester, NY 14642 USA

[7] Hop Laval, Inst Univ Cardiol Quebec, Quebec City, PQ, Canada

[8] Univ Montreal, Montreal Heart Inst, Montreal, PQ, Canada

[9] Univ Alberta, Div Cardiac Surg, Edmonton, AB, Canada

[10] Univ Virginia, Sch Med, Div Thorac & Cardiovasc Surg, Charlottesville, VA 22908 USA

[11] Duke Univ, Med Ctr, Dept Surg, Div Cardiovasc & Thorac Surg, Durham, NC 27710 USA

[12] Baylor Hlth Care Syst, Baylor Res Inst, Div Cardiothorac Surg, Plano, TX USA

[13] Univ Penn, Sch Med, Dept Surg, Div Cardiovasc Surg, Philadelphia, PA 19104 USA

[14] Christiana Care Hlth Syst, Ctr Heart & Vasc Hlth, Newark, DE USA

[15] Suburban Hosp, Ctr Heart, NIH, Dept Cardiothorac Surg, Bethesda, MD USA

[16] NHLBI, Off Biostat Res, Bethesda, MD 20892 USA

[17] NHLBI, Div Cardiovasc Sci, Bethesda, MD 20892 USA

[18] Univ Michigan Hlth Syst, Dept Cardiac Surg, Ann Arbor, MI USA

[19] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2015年 / 372卷 / 15期

基金：

美国国家卫生研究院; 加拿大健康研究院;

关键词：

RADIOFREQUENCY ABLATION; CONSENSUS-STATEMENT; CARDIAC-SURGERY; FOLLOW-UP; MAZE; APPENDAGE; CLOSURE; DISEASE; STROKE;

D O I：

10.1056/NEJMoa1500528

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P< 0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased.

引用

页码：1399 / 1409

页数：11

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