Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery: Risks and Benefits

Andrei Churyla, Adam Iddriss, Adin Christian Andrei, Jane Kruse, S. Chris Malaisrie, Rod Passman, Zhi Li, Richard Lee, Patrick M. McCarthy

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients. Methods From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39%) had preoperative atrial fibrillation, and of those, 724 (86%) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed. Results Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13% versus 7%; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72% BA versus 75% LA; p = 0.50), postoperative ablation (7% BA versus 5% LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79% BA versus 69% LA; p = 0.09), and no difference in permanent pacemaker placement (10% versus 12%; p = 0.57). Conclusions Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.

Original languageEnglish (US)
Pages (from-to)1858-1865
Number of pages8
JournalAnnals of Thoracic Surgery
Volume103
Issue number6
DOIs
StatePublished - Jun 2017

Fingerprint

Atrial Fibrillation
Mitral Valve
Anti-Arrhythmia Agents
Propensity Score
Survival
Stroke

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Churyla, A., Iddriss, A., Andrei, A. C., Kruse, J., Malaisrie, S. C., Passman, R., ... McCarthy, P. M. (2017). Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery: Risks and Benefits. Annals of Thoracic Surgery, 103(6), 1858-1865. https://doi.org/10.1016/j.athoracsur.2016.10.017

Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery : Risks and Benefits. / Churyla, Andrei; Iddriss, Adam; Andrei, Adin Christian; Kruse, Jane; Malaisrie, S. Chris; Passman, Rod; Li, Zhi; Lee, Richard; McCarthy, Patrick M.

In: Annals of Thoracic Surgery, Vol. 103, No. 6, 06.2017, p. 1858-1865.

Research output: Contribution to journalArticle

Churyla, A, Iddriss, A, Andrei, AC, Kruse, J, Malaisrie, SC, Passman, R, Li, Z, Lee, R & McCarthy, PM 2017, 'Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery: Risks and Benefits', Annals of Thoracic Surgery, vol. 103, no. 6, pp. 1858-1865. https://doi.org/10.1016/j.athoracsur.2016.10.017
Churyla, Andrei ; Iddriss, Adam ; Andrei, Adin Christian ; Kruse, Jane ; Malaisrie, S. Chris ; Passman, Rod ; Li, Zhi ; Lee, Richard ; McCarthy, Patrick M. / Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery : Risks and Benefits. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 6. pp. 1858-1865.
@article{39a1711b1d054b659dd2fc52fbac5e72,
title = "Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery: Risks and Benefits",
abstract = "Background Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients. Methods From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39{\%}) had preoperative atrial fibrillation, and of those, 724 (86{\%}) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed. Results Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13{\%} versus 7{\%}; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72{\%} BA versus 75{\%} LA; p = 0.50), postoperative ablation (7{\%} BA versus 5{\%} LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79{\%} BA versus 69{\%} LA; p = 0.09), and no difference in permanent pacemaker placement (10{\%} versus 12{\%}; p = 0.57). Conclusions Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.",
author = "Andrei Churyla and Adam Iddriss and Andrei, {Adin Christian} and Jane Kruse and Malaisrie, {S. Chris} and Rod Passman and Zhi Li and Richard Lee and McCarthy, {Patrick M.}",
year = "2017",
month = "6",
doi = "10.1016/j.athoracsur.2016.10.017",
language = "English (US)",
volume = "103",
pages = "1858--1865",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery

T2 - Risks and Benefits

AU - Churyla, Andrei

AU - Iddriss, Adam

AU - Andrei, Adin Christian

AU - Kruse, Jane

AU - Malaisrie, S. Chris

AU - Passman, Rod

AU - Li, Zhi

AU - Lee, Richard

AU - McCarthy, Patrick M.

PY - 2017/6

Y1 - 2017/6

N2 - Background Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients. Methods From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39%) had preoperative atrial fibrillation, and of those, 724 (86%) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed. Results Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13% versus 7%; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72% BA versus 75% LA; p = 0.50), postoperative ablation (7% BA versus 5% LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79% BA versus 69% LA; p = 0.09), and no difference in permanent pacemaker placement (10% versus 12%; p = 0.57). Conclusions Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.

AB - Background Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients. Methods From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39%) had preoperative atrial fibrillation, and of those, 724 (86%) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed. Results Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13% versus 7%; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72% BA versus 75% LA; p = 0.50), postoperative ablation (7% BA versus 5% LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79% BA versus 69% LA; p = 0.09), and no difference in permanent pacemaker placement (10% versus 12%; p = 0.57). Conclusions Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.

UR - http://www.scopus.com/inward/record.url?scp=85010782657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010782657&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2016.10.017

DO - 10.1016/j.athoracsur.2016.10.017

M3 - Article

C2 - 28017337

AN - SCOPUS:85010782657

VL - 103

SP - 1858

EP - 1865

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -