Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 31;34(4):540-547.
doi: 10.1093/icvts/ivab322.

Results of concomitant cryoablation for atrial fibrillation during mitral valve surgery

Alexander Bogachev-Prokophiev  1 , Ravil Sharifulin  1 , Anastasiia Karadzha  1 , Sergey Zheleznev  1 , Alexander Afanasyev  1 , Mikhail Ovcharov  1 , Alexey Pivkin  1 , Anton Zalesov  1 , Sergey Budagaev  1 , Sergey Ivantsov  1   2 , Alexander Chernyavsky  3
Affiliations

Results of concomitant cryoablation for atrial fibrillation during mitral valve surgery

Alexander Bogachev-Prokophiev et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: Concomitant atrial fibrillation ablation during mitral valve (MV) surgery using radio frequency energy sources has been reported previously with excellent outcomes. However, data regarding the effectiveness of concomitant cryoablation remain limited. This study aimed to assess the efficacy of concomitant cryoablation in patients scheduled for MV surgery.

Methods: Between 2012 and 2020, 242 adult patients who underwent MV surgery and concomitant cryoablation were included. Data on rhythm, medication status and clinical events were assessed at 3, 6 and 12 months, then annually thereafter.

Results: Early mortality was 0.4%. The mean follow-up period duration was 43.9 months. The survival rates at 1, 3 and 5 years were 97.3%, 94.3% and 87.7%, respectively. The rates of freedom from atrial arrhythmia paroxysms at 1, 3 and 5 years were 79.0%, 64.0% and 60.5%, respectively. Atrial arrhythmia recurrence was associated with isolated left atrial lesion set (P = 0.038), large right atrial size (P = 0.002), lower surgeon experience (P = 0.003) and atrial fibrillation paroxysms in the early postoperative period (P = 0.002).

Conclusions: Concomitant cryoablation during MV surgery is a safe and reproducible technique. The procedure provides acceptable freedom from atrial arrhythmias recurrences during long-term follow-up. The biatrial lesion set has advantages over the left atrium pattern in terms of atrial arrhythmias freedom. Surgeon experience significantly influences atrial fibrillation ablation success. Randomized trials are needed to compare radiofrequency and cryoablation.

Keywords: Atrial fibrillation; Cryoablation; Mitral valve disease.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Cryoablation lesion set performed in the study population. (A) Left atrial lesions. (B) Right atrial lesions. (C) Intraoperative photography. The dotted line depicts epicardial line to the coronary sinus. CS: coronary sinus; IVC: inferior vena cava; LAA: left atrial appendage; LPVs: left pulmonary veins; MV: mitral valve; RAA: right atrial appendage; RPVs: right pulmonary veins; SVC: superior vena cava; TV: tricuspid valve.
Figure 2:
Figure 2:
Survival of patients underwent concomitant cryoablation during mitral valve surgery.
Figure 3:
Figure 3:
Freedom from atrial arrhythmia paroxysms. AF: atrial fibrillation; Afl: atrial flutter; AT: atrial tachycardia.
Figure 4:
Figure 4:
Per cent of patients in sinus rhythm and sinus rhythm off antiarrhythmic drugs. AAD: antiarrhythmic drug.
Figure 5:
Figure 5:
Freedom from thromboembolic events.
None
See this image and copyright information in PMC

References

    1. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S.. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 2014;6:213–20. - PMC - PubMed
    1. Badhwar V, Rankin JS, Damiano RJ Jr, Gillinov AM, Bakaeen FG, Edgerton JR. et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg 2017;103:329–41. - PubMed
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B. et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893–962. - PubMed
    1. Gillinov AM, Gelijns AC, Parides MK, DeRose JJ, Moskowitz AJ, Voisine P. et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med 2015;372:1399–409. - PMC - PubMed
    1. Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM.. Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. J Thorac Cardiovasc Surg 2018;155:983–94. - PMC - PubMed