Recovery of atrial function after atrial compartment operation for chronic atrial fibrillation in mitral valve disease

Department of Emergency Medicine, Shin-Kong Memorial Hospital, Taipei, Taiwan, Republic of China.

OBJECTIVES. We prospectively studied the recovery of atrial function after atrial compartment operation and mitral valve surgery in patients with chronic atrial fibrillation caused by mitral valve disease. BACKGROUND. Chronic atrial fibrillation is the most common arrhythmia in mitral valve disease. This arrhythmia is associated with excessive morbidity and mortality. Mitral valve surgery alone rarely eliminates it. METHODS. Twenty-two patients underwent mitral valve surgery and a new surgical method, atrial compartment operation. Doppler echocardiography was performed in all patients before operation and at 1 week and 2 and 6 months after operation in the successful cardioversion group. Peak early diastolic (E) and atrial (A) filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves were measured. RESULTS. Sinus rhythm was restored immediately after operation in 91% of patients and was maintained for > 1 week in 15 (68%) of 22 patients and > 6 months in 14 (64%) of 22. Eleven of 15 patients had left atrial paralysis (A/E integral ratio 0) at 1 week and 6 of 14 patients at 2 months. Nine of 15 patients had right atrial paralysis (A/E integral ratio 0) at 1 week and 1 of 14 patients at 2 months. Both left and right atrial contractile function (presence of an A wave on Doppler findings) was detected at 6 months in 14 patients. Mean (+/- SD) peak atrial filling velocity of the mitral valve was 15 +/- 26 cm/s at 1 week, 38 +/- 39 cm/s at 2 months and 93 +/- 32 cm/s at 6 months (p < 0.001). Mean peak atrial filling velocity of the tricuspid valve was 14 +/- 19 cm/s at 1 week, 33 +/- 19 cm/s at 2 months and 50 +/- 19 cm/s at 6 months (p < 0.001). Peak early diastolic and atrial filling velocities, peak A/E velocity ratio and A/E integral ratio of the mitral and tricuspid valves increased significantly from 1 week to 6 months. CONCLUSIONS. Chronic atrial fibrillation in mitral valve disease can often be eliminated by atrial compartment operation. No surgical mortality or significant complications were encountered. Both left and right atrial function, as manifested by Doppler findings, recover after compartment operation and improve over time. The mechanical function of the right atrium recovers earlier than that of the left.

This article has been cited by other articles:

				G. B. Chierchia, C. de Asmundis, S.-A. Muller-Burri, A. Sarkozy, L. Capulzini, G. Paparella, S. Chierchia, M. Roos, and P. Brugada Early recovery of pulmonary vein conduction after cryoballoon ablation for paroxysmal atrial fibrillation: a prospective study Europace, April 1, 2009; 11(4): 445 - 449. [Abstract] [Full Text] [PDF]

				H.-M. Lo, F.-Y. Lin, and Y. Z. Tseng Atrial compartment operation for atrial fibrillation: to isolate the left atrium or not? Ann. Thorac. Surg., October 1, 2003; 76(4): 1259 - 1263. [Abstract] [Full Text] [PDF]

				F. Isobe, H. Kumano, T. Ishikawa, Y. Sasaki, S. Kinugasa, K. Nagamachi, and Y. Kato A new procedure for chronic atrial fibrillation: bilateral appendage-preserving maze procedure Ann. Thorac. Surg., November 1, 2001; 72(5): 1473 - 1478. [Abstract] [Full Text] [PDF]

				J.-L. Lin, L.-P. Lai, Y.-Z. Tseng, W.-P. Lien, and S. K. S. Huang Global distribution of atrial ectopic foci triggering recurrence of atrial tachyarrhythmia after electrical cardioversion of long-standing atrial fibrillation: a bi-atrial basket mapping study J. Am. Coll. Cardiol., March 1, 2001; 37(3): 904 - 910. [Abstract] [Full Text] [PDF]

				S. Benussi, C. Pappone, S. Nascimbene, G. Oreto, A. Caldarola, P. L. Stefano, V. Casati, and O. Alfieri A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach Eur J Cardiothorac Surg, May 1, 2000; 17(5): 524 - 529. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. C. Kelder, S. Elbers, A. B. de la Riviere, J. J. A. M. Defauw, and J. M. P. G. Ernst Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg, May 1, 2000; 17(5): 530 - 537. [Abstract] [Full Text] [PDF]

				E. R. Jessurun, N. M. van Hemel, J. A. M. T. Defauw, M. A. M. Stofmeel, J. C. Kelder, A. Brutel de la Riviere, and J. M. P. G. Ernst Results of Maze Surgery for Lone Paroxysmal Atrial Fibrillation Circulation, April 4, 2000; 101(13): 1559 - 1567. [Abstract] [Full Text] [PDF]

				K.-B. Kim, K. R. Cho, D.-W. Sohn, H. Ahn, and J. R. Rho The Cox-Maze III procedure for atrial fibrillation associated with rheumatic mitral valve disease Ann. Thorac. Surg., September 1, 1999; 68(3): 799 - 803. [Abstract] [Full Text] [PDF]

				P. B. Sparks, S. Jayaprakash, J. K. Vohra, H. G. Mond, A. G. Yapanis, L. E. Grigg, and J. M. Kalman Left atrial "stunning" following radiofrequency catheter ablation of chronic atrial flutter J. Am. Coll. Cardiol., August 1, 1998; 32(2): 468 - 475. [Abstract] [Full Text] [PDF]

				N. M. Sankar and A. E. Farnsworth Left atrial reduction for chronic atrial fibrillation associated with mitral valve disease Ann. Thorac. Surg., July 1, 1998; 66(1): 254 - 256. [Abstract] [Full Text] [PDF]

				M. A. Mitchell, I. D. McRury, and D. E. Haines Linear Atrial Ablations in a Canine Model of Chronic Atrial Fibrillation : Morphological and Electrophysiological Observations Circulation, March 31, 1998; 97(12): 1176 - 1185. [Abstract] [Full Text] [PDF]

				J. E. Olgin, J. M. Kalman, M. Chin, C. Stillson, M. Maguire, P. Ursel, and M. D. Lesh Electrophysiological Effects of Long, Linear Atrial Lesions Placed Under Intracardiac Ultrasound Guidance Circulation, October 21, 1997; 96(8): 2715 - 2721. [Abstract] [Full Text]

				A. Elvan, X.-d. Huang, M. L. Pressler, and D. P. Zipes Radiofrequency Catheter Ablation of the Atria Eliminates Pacing-Induced Sustained Atrial Fibrillation and Reduces Connexin 43 in Dogs Circulation, September 2, 1997; 96(5): 1675 - 1685. [Abstract] [Full Text]

				F.-Y. Lin, J.-H. Huang, J.-L. Lin, W.-J. Chen, H.-M. Lo, and S.-H. Chu ATRIAL COMPARTMENT SURGERY FOR CHRONIC ATRIAL FIBRILLATION ASSOCIATED WITH CONGENITAL HEART DEFECTS J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 231 - 237. [Abstract] [Full Text]

				A. Elvan, H. P. Pride, J. N. Eble, and D. P. Zipes Radiofrequency Catheter Ablation of the Atria Reduces Inducibility and Duration of Atrial Fibrillation in Dogs Circulation, April 15, 1995; 91(8): 2235 - 2244. [Abstract] [Full Text]