Atrial fibrillation ablation in patients undergoing aortic valve replacement

S. Chris Malaisrie, Richard Lee, Jane Kruse, Brittany Lapin, Edward C. Wang, Robert O. Bonow, Patrick M. McCarthy

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background and aim of the study: Current guidelines suggest that the use of a mechanical prosthesis is favored when patients are already receiving longterm anticoagulation for conditions such as atrial fibrillation (AF). Surgical AF ablation can restore normal sinus rhythm (NSR) and obviate the need for anticoagulation. The study aim was to determine the impact of concomitant AF ablation in patients with AF undergoing aortic valve replacement (AVR) on the restoration of NSR and subsequent requirement for anticoagulation. Methods: Between April 2004 and December 2009, a total of 124 patients (mean age 74 ± 12 years) with pre-existing AF underwent AVR with or without coronary artery bypass grafting. The documented preoperative rhythm was long-standing persistent AF in 39 patients (32%), persistent AF in five (4%), and paroxysmal AF in 80 (65%). Eighty patients (65%) had concomitant surgical AF ablation. In the ablation group, bilateral pulmonary vein isolation was performed in 55 cases (69%), left atrial-maze in 15 (19%), and Cox-maze in 10 (13%). A left atrial appendage closure was performed in 70 patients (88%). Sinus rhythm, in addition to anti-arrhythmic and warfarin use, were assessed between three and 15 months after surgery. Postoperatively, 13 patients died and 18 were lost to follow up during the three- to 15-month window; consequently, 71 patients were available for analysis in the ablation group, and 22 in the nonablation group. Results: In-hospital mortality was 4% (the Ambler score predicted a median (IQR) of 6 (4-9)%). Freedom from AF when not receiving anti-arrhythmic drugs (AADs) occurred in 58 patients (82%) in the ablation group, compared to eight (36%) in the non-ablation group (p <0.001). Fifty patients (70%) were free from warfarin in the ablation group, compared to six (27%) in the non-ablation group (p <0.001). No differences were identified in freedom from AF between the surgical AF lesion sets. AF ablation, younger age, and paroxysmal AF were independently associated with freedom from AF when not receiving AADs. Conclusion: Surgical AF ablation is associated with an improved restoration of NSR in patients with AF requiring AVR. The need for anticoagulation is reduced in the majority of patients. A bioprosthetic valve may be an acceptable option for a patient with AF who requires AVR.

Original languageEnglish (US)
Pages (from-to)350-357
Number of pages8
JournalJournal of Heart Valve Disease
Volume21
Issue number3
StatePublished - May 1 2012
Externally publishedYes

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Aortic Valve
Atrial Fibrillation
Anti-Arrhythmia Agents
Warfarin
Atrial Appendage
Pulmonary Veins
Lost to Follow-Up
Hospital Mortality
Coronary Artery Bypass
Pharmaceutical Preparations
Prostheses and Implants

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Malaisrie, S. C., Lee, R., Kruse, J., Lapin, B., Wang, E. C., Bonow, R. O., & McCarthy, P. M. (2012). Atrial fibrillation ablation in patients undergoing aortic valve replacement. Journal of Heart Valve Disease, 21(3), 350-357.

Atrial fibrillation ablation in patients undergoing aortic valve replacement. / Malaisrie, S. Chris; Lee, Richard; Kruse, Jane; Lapin, Brittany; Wang, Edward C.; Bonow, Robert O.; McCarthy, Patrick M.

In: Journal of Heart Valve Disease, Vol. 21, No. 3, 01.05.2012, p. 350-357.

Research output: Contribution to journalArticle

Malaisrie, SC, Lee, R, Kruse, J, Lapin, B, Wang, EC, Bonow, RO & McCarthy, PM 2012, 'Atrial fibrillation ablation in patients undergoing aortic valve replacement', Journal of Heart Valve Disease, vol. 21, no. 3, pp. 350-357.
Malaisrie SC, Lee R, Kruse J, Lapin B, Wang EC, Bonow RO et al. Atrial fibrillation ablation in patients undergoing aortic valve replacement. Journal of Heart Valve Disease. 2012 May 1;21(3):350-357.
Malaisrie, S. Chris ; Lee, Richard ; Kruse, Jane ; Lapin, Brittany ; Wang, Edward C. ; Bonow, Robert O. ; McCarthy, Patrick M. / Atrial fibrillation ablation in patients undergoing aortic valve replacement. In: Journal of Heart Valve Disease. 2012 ; Vol. 21, No. 3. pp. 350-357.
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AU - Malaisrie, S. Chris

AU - Lee, Richard

AU - Kruse, Jane

AU - Lapin, Brittany

AU - Wang, Edward C.

AU - Bonow, Robert O.

AU - McCarthy, Patrick M.

PY - 2012/5/1

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N2 - Background and aim of the study: Current guidelines suggest that the use of a mechanical prosthesis is favored when patients are already receiving longterm anticoagulation for conditions such as atrial fibrillation (AF). Surgical AF ablation can restore normal sinus rhythm (NSR) and obviate the need for anticoagulation. The study aim was to determine the impact of concomitant AF ablation in patients with AF undergoing aortic valve replacement (AVR) on the restoration of NSR and subsequent requirement for anticoagulation. Methods: Between April 2004 and December 2009, a total of 124 patients (mean age 74 ± 12 years) with pre-existing AF underwent AVR with or without coronary artery bypass grafting. The documented preoperative rhythm was long-standing persistent AF in 39 patients (32%), persistent AF in five (4%), and paroxysmal AF in 80 (65%). Eighty patients (65%) had concomitant surgical AF ablation. In the ablation group, bilateral pulmonary vein isolation was performed in 55 cases (69%), left atrial-maze in 15 (19%), and Cox-maze in 10 (13%). A left atrial appendage closure was performed in 70 patients (88%). Sinus rhythm, in addition to anti-arrhythmic and warfarin use, were assessed between three and 15 months after surgery. Postoperatively, 13 patients died and 18 were lost to follow up during the three- to 15-month window; consequently, 71 patients were available for analysis in the ablation group, and 22 in the nonablation group. Results: In-hospital mortality was 4% (the Ambler score predicted a median (IQR) of 6 (4-9)%). Freedom from AF when not receiving anti-arrhythmic drugs (AADs) occurred in 58 patients (82%) in the ablation group, compared to eight (36%) in the non-ablation group (p <0.001). Fifty patients (70%) were free from warfarin in the ablation group, compared to six (27%) in the non-ablation group (p <0.001). No differences were identified in freedom from AF between the surgical AF lesion sets. AF ablation, younger age, and paroxysmal AF were independently associated with freedom from AF when not receiving AADs. Conclusion: Surgical AF ablation is associated with an improved restoration of NSR in patients with AF requiring AVR. The need for anticoagulation is reduced in the majority of patients. A bioprosthetic valve may be an acceptable option for a patient with AF who requires AVR.

AB - Background and aim of the study: Current guidelines suggest that the use of a mechanical prosthesis is favored when patients are already receiving longterm anticoagulation for conditions such as atrial fibrillation (AF). Surgical AF ablation can restore normal sinus rhythm (NSR) and obviate the need for anticoagulation. The study aim was to determine the impact of concomitant AF ablation in patients with AF undergoing aortic valve replacement (AVR) on the restoration of NSR and subsequent requirement for anticoagulation. Methods: Between April 2004 and December 2009, a total of 124 patients (mean age 74 ± 12 years) with pre-existing AF underwent AVR with or without coronary artery bypass grafting. The documented preoperative rhythm was long-standing persistent AF in 39 patients (32%), persistent AF in five (4%), and paroxysmal AF in 80 (65%). Eighty patients (65%) had concomitant surgical AF ablation. In the ablation group, bilateral pulmonary vein isolation was performed in 55 cases (69%), left atrial-maze in 15 (19%), and Cox-maze in 10 (13%). A left atrial appendage closure was performed in 70 patients (88%). Sinus rhythm, in addition to anti-arrhythmic and warfarin use, were assessed between three and 15 months after surgery. Postoperatively, 13 patients died and 18 were lost to follow up during the three- to 15-month window; consequently, 71 patients were available for analysis in the ablation group, and 22 in the nonablation group. Results: In-hospital mortality was 4% (the Ambler score predicted a median (IQR) of 6 (4-9)%). Freedom from AF when not receiving anti-arrhythmic drugs (AADs) occurred in 58 patients (82%) in the ablation group, compared to eight (36%) in the non-ablation group (p <0.001). Fifty patients (70%) were free from warfarin in the ablation group, compared to six (27%) in the non-ablation group (p <0.001). No differences were identified in freedom from AF between the surgical AF lesion sets. AF ablation, younger age, and paroxysmal AF were independently associated with freedom from AF when not receiving AADs. Conclusion: Surgical AF ablation is associated with an improved restoration of NSR in patients with AF requiring AVR. The need for anticoagulation is reduced in the majority of patients. A bioprosthetic valve may be an acceptable option for a patient with AF who requires AVR.

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