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Atrial function after epicardial microwave ablation in patients with atrial fibrillation
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-6913-0669
Örebro University, School of Health and Medical Sciences.
2008 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 192-201Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study epicardial microwave ablation of concomitant atrial fibrillation and its effects on heart rhythm and atrial function during follow-up. DESIGN: The study included 20 open-heart surgery patients with concomitant atrial fibrillation. Transthoracic echocardiography with flow and tissue Doppler recordings was performed preoperatively and at 6 months postoperatively. Blood samples were obtained preoperatively and postoperatively for analysis of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and amino terminal precursor of brain natriuretic peptide (NT-proBNP). RESULTS: Fourteen of 19 patients (74%) were in sinus rhythm with no antiarrhythmic drugs at 12 months. All patients in sinus rhythm had preserved left and right atrial-filling waves through atrioventricular valves during atrial contraction. Tissue velocity echocardiography on patients in sinus rhythm showed preserved atrial wall velocities, atrial strain, and atrial strain rate. Levels of natriuretic peptides tended to decrease in patients with stable sinus rhythm at one year compared to patients in atrial fibrillation. CONCLUSIONS: Epicardial microwave ablation results in sinus rhythm in a majority of patients and seems to preserve atrial mechanical function

Place, publisher, year, edition, pages
2008. Vol. 42, no 3, p. 192-201
Keywords [en]
Aged, Atrial Fibrillation/metabolism/physiopathology/*surgery/ultrasonography, Atrial Function, Atrial Natriuretic Factor/blood, Biological Markers/blood, Catheter Ablation/adverse effects/*methods, Echocardiography; Doppler, Female, Heart Conduction System/*physiopathology, Humans, Male, Microwaves/*therapeutic use, Middle Aged, Myocardial Contraction, Natriuretic Peptide; Brain/blood, Peptide Fragments/blood, Pericardium/*surgery, Prospective Studies, Time Factors, Treatment Outcome
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-3585DOI: 10.1080/14017430701882418PubMedID: 18569951OAI: oai:DiVA.org:oru-3585DiVA, id: diva2:137883
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Atrial fibrillation in cardiac surgery
Open this publication in new window or tab >>Atrial fibrillation in cardiac surgery
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF.

In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF.

All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF.

All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87).

Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain.

In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 18
Keywords
Atrial fibrillation, Inflammation, CABG surgery, Survival analysis, Follow-up studies, Ablation, Microwave, Transmurality, Atrial function, Tissue velocity echocardiography
National Category
Surgery
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
urn:nbn:se:oru:diva-2442 (URN)978-91-7668-615-7 (ISBN)
Public defence
2008-09-19, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved

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Ahlsson, AndersEnglund, Anders

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