The Surgical Treatment of Atrial Fibrillation in Patients undergoing Simultaneous Open Heart Surgery

Lee, Chang Ha; Kim, Ki Bong; Sohn, Dae Won; Rho, Joon Ryang

Abstract

Atrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of the patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze III procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defect (VSD). Mean duration of atrial fibrillation was 36 months (+/-42 months) (range, 1 to 132 months). The past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombi was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVR and tricuspid annuloplasty (TAP) in 4, mitral valvuloplasty (MVP) in 3, MVP and TVP in 1, MVP and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, however, the recurrent atrial fibrillation converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegia in 1, and acute renal failure in 1. Mean follow-up interval of the patients was 16.5 months (range, 10.5 to 24 months) and all the patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.