WHEN AND HOW TO REPORT RESULTS OF SURGERY ON ATRIAL-FIBRILLATION

Objective: Several medical, interventional and surgical techniques are used to treat atrial fibrillation, aimed at different goals and havin g variable success rates. To be able to assess and compare all these t echniques a methodology of study and a classification is proposed. Met hods: We developed a five grade score, named the Santa Crus Score, bas ed upon the post-operative atrial rhythm and the effective atrial cont raction. Score 0 corresponds to a persistence of atrial fibrillation, the presence of a regular rhythm is grade 1, 2 or 3 if there is no atr ial contraction; right atrial contraction; or bilateral atrial contrac tion, respectively. Score 4 corresponds to sinus rhythm and bilateral atrial contraction. Surgery for atrial fibrillation was performed on 5 1 patients since 1992. All patients but two had associated mitrial sur gery. Three different maze techniques were performed on 17 patients an d the pulmonary viens isolation procedure on 34 patients. Patients wer e reassessed at 1, 6, 12, 24 and 36 months, Results: After the maze I procedure atrial fibrillation eradication was achieved in 88% of patie nts but none scored 4. Three patients changed score during the first y ear. All maze III patients scored 0 initially and one changed to score 3 in the first year. Sixty percent of the maze IIIA patients scored 4 , but one evolved to score 0 at 6 months. The pulmonary veins isolatio n technique eliminated atrial fibrillation in 71% of the patients init ially, and in 60% after 1 year, and achieved a score of 4 in a third o f the patients. Conclusion: This classification considers the intermed iate grades of success that can occur with absence of atrial fibrillat ion and is applicable to all forms of therapy. (C) 1997 Elsevier Scien ce B.V.