A. Marc Gillinov, MD, Sekar Bhavani, MD, Eugene H

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Presentation transcript:

Surgery for Permanent Atrial Fibrillation: Impact of Patient Factors and Lesion Set A. Marc Gillinov, MD, Sekar Bhavani, MD, Eugene H. Blackstone, MD, Jeevanantham Rajeswaran, MS, Lars G. Svensson, MD, PhD, Jose L. Navia, MD, B.Gösta Pettersson, MD, PhD, Joseph F. Sabik, MD, Nicholas G. Smedira, MD, Tomislav Mihaljevic, MD, Patrick M. McCarthy, MD, Jeanne Shewchik, RN, Andrea Natale, MD The Annals of Thoracic Surgery Volume 82, Issue 2, Pages 502-514 (August 2006) DOI: 10.1016/j.athoracsur.2006.02.030 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Left atrial lesion set of the Cox-maze III procedure. White oval represents mitral valve, 4 blank ovals pulmonary veins, and dashed lines are sites of incision and(or) cryoablation. Right atrial lesions are not depicted. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schematic representation of left atrial lesion sets created with alternative energy sources. White oval represents mitral valve, 4 blank ovals pulmonary veins, and dashed lines sites of ablation. Most ablation lesions are created with bipolar radiofrequency except in lesion sets 3 and 4, where the lesion connecting the left pulmonary vein lesion to the mitral valve anulus is created with cryothermy. Some patients receiving lesion sets 2, 3, and 4 also had right atrial lesions, most commonly a lesion on the right atrial isthmus. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Number of patients with electrocardiographic (ECG) follow-up available at and beyond various time points, and number of ECGs available for analysis. (White bars = patients; grey bars = ECGs.) The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Temporal pattern of atrial fibrillation (AF) after ablation based on postoperative electrocardiograms. (A) Estimated prevalence of AF. (Solid line = mean prevalence; dashed lines = 68% confidence limits). (B) Temporal decomposition of prevalence of AF demonstrating two additive phases: an early peaking phase and a late phase. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Risk-adjusted prevalence of atrial fibrillation (AF) demonstrating impact of different lesion sets in a hypothetical patient having mitral valve repair (see Figs 1 and 2). Except for variables depicted, values for other risk factors were set as follows: age, 66 years; left atrial volume index, 41 mL·m−2; duration of AF, 48 months; hematocrit, 39%; relative wall thickness, 0.44. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Prevalence at 1 year of postoperative atrial fibrillation (AF) demonstrating effects of factors identified by multivariable analysis (see Table 3). Except for variables depicted, values for other risk factors were set as follows: age, 66 years; left atrial (LA) volume index, 41 mL·m−2; duration of AF, 48 months; hematocrit, 39%; relative wall thickness, 0.44. (A) LA volume index; (B) patient age; and (C) duration of preoperative AF. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Appendix 3: Fig 1 Prevalence of class I/III anti-arrhythmic use at time of each follow-up. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Appendix 3: Fig 2 Prevalence of warfarin use at time of each follow-up. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Appendix 3: Fig 3 Cumulative number of cardioversions per patient over time. The Annals of Thoracic Surgery 2006 82, 502-514DOI: (10.1016/j.athoracsur.2006.02.030) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions