Successful Surgical Ablation Of Lone-Standing, Persistent Atrial Fibrillation Improves Left Atrial Transport Function
Gianluigi Bisleri1, Tania Bordonali1, Enrico Vizzardi1, Nicola Berlinghieri1, Faisal Cheema2, Claudio Muneretto1.
1University of Brescia Medical School, Brescia, Italy, 2Columbia College of Physicians & Surgeons, New York, NY, USA.
Although minimally invasive surgical treatment of lone-standing atrial fibrillation (AF) has gained popularity in recent years thanks to its encouraging results, the atrial performance following surgical ablation in patients with persistent AF has not been widely investigated so far.
Among 35 patients with lone-standing, persistent AF undergoing closed-chest surgical ablation via an epicardial encircling of the pulmonary veins(box lesion set), twenty patients with stable sinus rhythm at follow-up were enrolled in the study. Long-standing (>1yr) persistent AF was present in most of patients (15/20, 75%) while only 25%(5/20) of patients had persistent AF(<1yr).Pre-operatively and at follow-up, echocardiographic evaluation was performed by means of echocardiographic parameters such as: LA (left atrial) antero-posterior diameter(LA-AP diam), LA volumes (maximum, minimum), LA total empyting fraction(LA-TEF), LA active emptying fraction(LA-AEF), LA passive empyting fraction(LA-PAF).
At a mean follow-up of 875±122 days, all twenty patients underwent an echocardiographic follow-up: we could observe a reduction in LA antero-posterior diameters (pre-op=49.7±3 vs post-op=43.6±6.3 , p=0.13) albeit not statistically significant; moreover, indexed LA diameters were: maximum=36.3±12 mL/m2, minimum=24.6±10.7 mL/m2, at the onset of A wave= 30±10.4 mL/m2. LA-TEF was 33%, while LA-AEF and LA-PAF were 19% and 16% respectively (p<0.01 versus pre-operative values).
Successful ablation with the box lesion set was associated with a reduction in LA-AP diameter in patients with pre-operative lone-standing persistent AF. Moreover, when compared to the complete absence of pre-operative atrial function, the LA function was significantly improved either in terms of reservoir, conduit, and pump activity.
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