Surgical ablation of atrial fibrillation during mitral-valve surgery
Open accessAbstract
BACKGROUND: Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. METHODS: We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). RESULTS: More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. CONCLUSIONS: The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.).
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The Cox maze procedure and other forms of atrial fibrillation surgery have mainly been used in patients undergoing other open heart surgical procedures.
“The Cox maze procedure and other, often simpler, forms of AF surgery have mainly been used in patients undergoing other open heart surgical procedures.461,466,[784][785][786][787][788][789][790][791][792][793][794][795][796][797][798]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [466]
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Gillinov, A. M., Gelijns, A. C., Parides, M. K., DeRose, J. J., Moskowitz, A. J., Voisine, P., Ailawadi, G., Bouchard, D., Smith, P. K., Mack, M. J., Acker, M. A., Mullen, J. C., Rose, E. A., Chang, H. L., Puskas, J. D., Couderc, J.-P., Gardner, T. J., Varghese, R., Horvath, K. A., Bolling, S. F., Michler, R. E., Geller, N. L., Ascheim, D. D., Miller, M. A., Bagiella, E., Moquete, E. G., Williams, P., Taddei-Peters, W. C., O'Gara, P. T., Blackstone, E. H., & Argenziano, M.
- Affiliations
- Cleveland Clinic (US)
- Icahn School of Medicine at Mount Sinai (US)
- University of Virginia Medical Center (US)
- Montreal Heart Institute (CA)
- Duke Medical Center (US)
- University of Pennsylvania (US)
- University of Alberta (CA)
- Mount Sinai Health System (US)
- University of Rochester Medicine (US)
- Christiana Care Health System (US)
- National Institutes of Health (US)
- Michigan Medicine (US)
- Albert Einstein College of Medicine (US)
- National Heart, Lung, and Blood Institute (US)
- Columbia University Irving Medical Center (US)
- ORCID
- Gillinov, A. Marc
- Gelijns, Annetine C.
- Parides, Michael K.
- DeRose, Joseph J.
- Moskowitz, Alan J.
- Voisine, Pierre
- Ailawadi, Gorav
- Bouchard, Denis
- Mack, Michael J.
- Chang, Helena L.
- Puskas, John D.
- Couderc, Jean-Philippe
- Varghese, Robin
- Michler, Robert E.
- Geller, Nancy L.
- Miller, Marissa A.
- Bagiella, Emilia
- Blackstone, Eugene H.
- Argenziano, Michael
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-04-09
- Volume
- 372
- Issue
- 15
- Pages
- 1399-1409
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4664179
- OpenAlex
- W2108591114
- Cited by
- 490
- References
- 41
- Citations by year
- 2026: 21 · 2025: 40 · 2024: 52 · 2023: 20 · 2022: 53 · 2021: 42 · 2020: 50 · 2019: 32 · 2018: 57 · 2017: 56 · 2016: 35 · 2015: 31
- FWCI
- 43.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Canadian Institutes of Health Research
- National Heart, Lung, and Blood Institute (UM1HL117922, UM1HL088939, UM1HL088955, U01HL088942)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, surgical ablation, mitral valve surgery, pulmonary vein isolation, left atrial appendage closure, persistent atrial fibrillation, long-standing persistent atrial fibrillation, permanent pacemaker implantation, mortality, stroke risk
- MeSH terms
- Aged, Atrial Fibrillation, Cardiovascular Diseases, Female, Heart Valve Diseases, Humans, Male, Middle Aged, Mitral Valve, Postoperative Complications, Quality of Life, Electrocardiography, Ambulatory, Catheter Ablation, Heart Valve Prosthesis Implantation, Kaplan-Meier Estimate, Secondary Prevention
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