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Patients with AF benefit from biatrial maze procedure during mitral valve surgery
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Weekly transtelephonic monitoring in patients with atrial fibrillation who had mitral valve surgery showed decreased atrial fibrillation prevalence and burden after biatrial maze vs. pulmonary vein isolation, according to results presented at AATS Week.
The results, from the Cardiothoracic Surgical Trials Network study, were presented by Marc Gillinov, MD, of the department of thoracic and cardiovascular surgery at the Heart & Vascular Institute at Cleveland Clinic.
In the main study, published in 2015, 260 patients were randomly assigned to mitral valve surgery alone or mitral valve surgery plus surgical ablation. The surgical ablation group was further randomly assigned to biatrial maze or pulmonary vein isolation.
For the present study, Gillinov and colleagues conducted a longitudinal analysis including 228 patients (88%) who submitted 7,949 transtelephonic monitoring assessments up to 1 year after surgery.
The researchers had previously found that those assigned surgery plus ablation were more likely to be free of AF, as assessed by 72-hour Holter monitoring, at 12 months, compared with those assigned surgery alone (63% vs. 29%; P < .001); however, there was no apparent difference between lesion sets based on Holter monitoring.
During the presentation, Gillinov reported the results of more extensive heart rhythm monitoring using thousands of transtelephonic strips. Based on these recordings, 12-month freedom from AF was higher in the biatrial maze group compared with the pulmonary vein isolation group (OR = 2.31; 95% CI, 0.95-5.65).
Prevalence of AF as estimated by transtelephonic monitoring assessment at 12 months was 59% after mitral valve surgery alone, 40% after surgery plus pulmonary vein isolation and 25% after surgery plus biatrial maze (P < .04 for pulmonary vein isolation vs. biatrial maze), according to the researchers.
Cumulative AF burden was lower after biatrial maze than after pulmonary vein isolation (1.5 months vs. 2.6 months), Gillinov and colleagues found.
In an interview with Cardiology Today, Gillinov said a goal was “to see if through more intensive monitoring we might be able to discern a difference between pulmonary vein isolation vs. the biatrial maze.”
“The first takeaway is the biatrial maze procedure, which is more extensive, seems to be more effective in treating AF in mitral valve patients,” Gillinov said. “The second takeaway is that the monitoring strategy, whether it’s [ECG], Holter monitors or [transtelephonic monitoring] influence the results obtained and therefore, we actually need more studies that consider different monitoring strategies in patients with arrhythmias who [require mitral valve surgery].”– by Dave Quaile
Reference:
Blackstone EH, et al. LB8. Presented at: AATS Week 2017; April 29-May 3, 2017; Boston.
Disclosure: Gillinov reports financial ties with Abbott, AtriCure, Clear Catheter, CryoLife, Edwards Lifesciences and Medtronic.