Atrial Size Reduction and Right Pulmonary Vein Isolation for Treatment of Atrial Fibrillation in Mitral Valve Surgery

Pulmonary vein focal activity and left atrial size are major factors in the initiation and maintenance of atrial fibrillation. We tested a technically safe and simple method of atrial size reduction and right pulmonary vein exclusion on its effectiveness to restore sinus rhythm. The technique had to be compatible with a minimally invasive approach. From November 2001 to July 2002, 25 patients (mean age 62?12) suffering from chronic atrial fibrillation associated with mitral valve disease were included. Atrial size reduction was achieved by closure of the left atrial appendage, plication of the posterior left atrial wall and septum. The right pulmonary vein was dissected and reanastomosed. Nine of the operations were performed minimally invasive using the Chitwood technique. Mean cardiopulmonary bypass and aortic cross clamp times were 149?37 min and 89?22 min. respectively. There were no peri- or postoperative deaths. Atrial diameter, evaluated by repeated echocardiography, was reduced from 52?9 mm to 44?8 mm. All patients could be converted to sinus rhythm intraoperatively. During hospital stay 80% of patients returned to atrial fibrillation, but conversion rate increased significantly during follow-up. One year after surgery, 83,3 % of patients showed stable sinus rhythm with reduced antiarrhythmic medication. Exclusion of the right pulmonary veins in combination with left atrial size reduction added little complexity and risk to mitral valve surgery. Stable sinus rhythm was present in 83% of patients at one year follow up. Additional radio frequency ablation is currently evaluated and may further improve results.