Efficacy of pulmonary vein isolation for the elimination of chronic atrialfibrillation in cardiac valvular surgery

Background. Haissaguerre and colleagues emphasize the importance of the pul monary veins as a source of ectopic foci for initiating paroxysmal atrial f ibrillation (AF). We hypothesized that ectopic foci from the pulmonary vein s could also act as drivers for maintaining chronic AF, and that surgical a blation of the pulmonary vein orifices could terminate chronic AF. Methods. Using a computerized 48-channel mapping system, we performed intra operative atrial mapping in 12 patients with chronic AF associated with mit ral valve disease. Patient age ranged from 24 to 82 years (mean, 60.4 years ). AF duration ranged from 3 to 240 months (mean, 92 +/- 84 months). Simple surgical isolation of the pulmonary vein orifices was performed during the mitral valve operation. Results. Regular and repetitive activation was found in the left atria of 9 out of 12 patients, and irregular and chaotic activation was found in both atria df 3 out of 12 patients. Chronic AF in the 9 patients (75%) with reg ular and repetitive activation of their left atria was successfully treated by a simple surgical isolation of the pulmonary vein orifices. The other 3 patients did not recover sinus rhythm after this procedure. In 1 case of r ecurrent AF, the patient recovered sinus rhythm during the follow-up period (AF-free rate, 83%). Conclusions. Surgical ablation of the pulmonary vein orifices was effective in the treatment of chronic AF associated with mitral valve disease. Intra operative mapping may be useful in predicting the efficacy of a single pulm onary vein orifice isolation procedure. (C) 2001 by The Society of Thoracic Surgeons.