Surgical ablation of atrial fibrillation during mitral-valve surgery

CTSN Investigators

Research output: Contribution to journalArticle

162 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1399-1409
Number of pages11
JournalNew England Journal of Medicine
Volume372
Issue number15
DOIs
StatePublished - Apr 9 2015

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Mitral Valve
Atrial Fibrillation
Pulmonary Veins
Control Groups
Patient Readmission
Atrial Appendage
Ambulatory Electrocardiography
Random Allocation
Stroke
Confidence Intervals
Safety
Survival
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Surgical ablation of atrial fibrillation during mitral-valve surgery. / CTSN Investigators.

In: New England Journal of Medicine, Vol. 372, No. 15, 09.04.2015, p. 1399-1409.

Research output: Contribution to journalArticle

CTSN Investigators. / Surgical ablation of atrial fibrillation during mitral-valve surgery. In: New England Journal of Medicine. 2015 ; Vol. 372, No. 15. pp. 1399-1409.
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abstract = "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.",
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T1 - Surgical ablation of atrial fibrillation during mitral-valve surgery

AU - CTSN Investigators

AU - Gillinov, A. Marc

AU - Gelijns, Annetine C.

AU - Parides, Michael K.

AU - DeRose, Joseph

AU - Moskowitz, Alan J.

AU - Voisine, Pierre

AU - Ailawadi, Gorav

AU - Bouchard, Denis

AU - Smith, Peter K.

AU - Mack, Michael J.

AU - Acker, Michael A.

AU - Mullen, John C.

AU - Rose, Eric A.

AU - Chang, Helena L.

AU - Puskas, John D.

AU - Couderc, Jean Philippe

AU - Gardner, Timothy J.

AU - Varghese, Robin

AU - Horvath, Keith A.

AU - Bolling, Steven F.

AU - Michler, Robert E.

AU - Geller, Nancy L.

AU - Ascheim, Deborah D.

AU - Miller, Marissa A.

AU - Bagiella, Emilia

AU - Moquete, Ellen G.

AU - Williams, Paula

AU - Taddei-Peters, Wendy C.

AU - O'Gara, Patrick T.

AU - Blackstone, Eugene H.

AU - Argenziano, Michael

PY - 2015/4/9

Y1 - 2015/4/9

N2 - 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.

AB - 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.

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U2 - 10.1056/NEJMoa1500528

DO - 10.1056/NEJMoa1500528

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JF - New England Journal of Medicine

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