Left Atrial Function Following Surgical Ablation of Atrial Fibrillation: Prospective Evaluation Using Dual-Source Cardiac Computed Tomography
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: The Maze procedure has shown excellent efficacy in the elimination of atrial fibrillation (AF); however, little is known about the quality of functional recoveryin the left atrium (LA) following successful sinus rhythm conversion by the Maze procedure. Materials and Methods: We prospectively enrolled 12 patients(aged 52.5±10.1 years, 1 female) with valvular AF undergoing mitral valve surgery combined with the Maze procedure. Parameters of LA function in three anatomic compartments [anterior, posterior, and LA appendage (LAA)] were evaluatedusing electrocardiography-gated dual-source cardiac CT at one month and at six months after surgery. Twelve subjects matched by age, gender, and body surfacearea served as controls. Results: At one month after surgery, ejection fraction (EF) and emptying volume (EV) of the LA were 14.9±7.4% and 21.3±9.7 mL, respectively,and they were significantly lower than those of the control group (EF, 47.9±11.2%; EV, 46.0±10.7%; p<0001). These values did not significantly change throughout late periods (p=0.22 and 0.21, respectively). Functional contributions of the anterior, posterior, and appendage compartments (EV of each compartment/overall EV) were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection (n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects (p<0.001). Conclusion:Contractile functions of the LA significantly decreased after the Maze procedure. Functional contributions of three compartments of the LA were also altered. The influence of LAA preservation on postoperative LA functions needs to be evaluated through studies of larger populations.
Abstract
Purpose: The Maze procedure has shown excellent efficacy in the elimination of atrial fibrillation (AF); however, little is known about the quality of functional recoveryin the left atrium (LA) following successful sinus rhythm conversion by the Maze procedure. Materials and Methods: We prospectively enrolled 12 patients(aged 52.5±10.1 years, 1 female) with valvular AF undergoing mitral valve surgery combined with the Maze procedure. Parameters of LA function in three anatomic compartments [anterior, posterior, and LA appendage (LAA)] were evaluatedusing electrocardiography-gated dual-source cardiac CT at one month and at six months after surgery. Twelve subjects matched by age, gender, and body surfacearea served as controls. Results: At one month after surgery, ejection fraction (EF) and emptying volume (EV) of the LA were 14.9±7.4% and 21.3±9.7 mL, respectively,and they were significantly lower than those of the control group (EF, 47.9±11.2%; EV, 46.0±10.7%; p<0001). These values did not significantly change throughout late periods (p=0.22 and 0.21, respectively). Functional contributions of the anterior, posterior, and appendage compartments (EV of each compartment/overall EV) were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection (n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects (p<0.001). Conclusion:Contractile functions of the LA significantly decreased after the Maze procedure. Functional contributions of three compartments of the LA were also altered. The influence of LAA preservation on postoperative LA functions needs to be evaluated through studies of larger populations.
참고문헌 (29)
- Ad N, "The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation", Eur J Cardiothorac Surg, 40, pp.70~76 (2011)
- Bando K, "Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation", J Thorac Cardiovasc Surg, 129, pp.1032~1040 (2005)
- Cohn LH, "Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve", J Thorac Cardiovasc Surg, 107, pp.143~150 (1994)
- Cox JL, "Impact of the maze procedure on the stroke rate in patients with atrial fibrillation", J Thorac Cardiovasc Surg, 118, pp.833~840 (1999)
- Cox JL, "Successful surgical treatment of atrial fibrillation. Review and clinical update", JAMA, 266, pp.1976~1980 (1991)
- Gillinov AM, "The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation", J Thorac Cardiovasc Surg, 130, pp.1653~1660 (2005)
- Kim JB, "Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure", Circulation, 125, pp.2071~2080 (2012)
- Park MJ, "Assessment of the structural remodeling of the left atrium by 64-multislice cardiac CT: comparative studies in controls and patients with atrial fibrillation", Int J Cardiol, 159, pp.181~186 (2012)
- Yamanaka K, "Multislice computed tomography accurately quantifies left atrial size and function after the MAZE procedure", Circulation, 114(1 Suppl), pp.I5~I9 (2006)
- den Uijl DW, "Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation", Am J Cardiol, 107, pp.243~249 (2011)
- Kataoka A, "Quantitative evaluation of left atrial volumes and ejection fraction by 320-slice computed-tomography in comparison with three- and two-dimensional echocardiography: a single-center retrospective-study in 22 subjects", Int J Cardiol, 153, pp.47~54 (2011)
- Kim JB, "Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation", Ann Thorac Surg, 92, pp.1397~1404 (2011)
- Kerut EK, "Anatomy of the left atrial appendage", Echocardiography, 25, pp.669~673 (2008)
- Abhayaratna WP, "Left atrial size: physiologic determinants and clinical applications", J Am Coll Cardiol, 47, pp.2357~2363 (2006)
- Middlekauff HR, "Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients", Circulation, 84, pp.40~48 (1991)
- Pritchett EL, "Management of atrial fibrillation", N Engl J Med, 326, pp.1264~1271 (1992)
- Feinberg MS, "Restoration of atrial function after the maze procedure for patients with atrial fibrillation. Assessment by Doppler echocardiography", Circulation, 90(5 Pt 2), pp.II285~II292 (1994)
- Yashima N, "Serial evaluation of atrial function by Doppler echocardiography after the maze procedure for chronic atrial fibrillation", Eur Heart J, 18, pp.496~502 (1997)
- Jessurun ER, "The effect of maze operations on atrial volume", Ann Thorac Surg, 75, pp.51~56 (2003)
- Anderson RH, "The structure and components of the atrial chambers", Europace, 9(Suppl 6), pp.vi3~vi9 (2007)
- Cox JL, "The central controversy surrounding the interventional-surgical treatment of atrial fibrillation", J Thorac Cardiovasc Surg, 129, pp.1~4 (2005)
- Lönnerholm S, "Effects of the maze operation on health-related quality of life in patients with atrial fibrillation", Circulation, 101, pp.2607~2611 (2000)
- Henry WL, "Relation between echocardiographically determined left atrial size and atrial fibrillation", Circulation, 53, pp.273~279 (1976)
- Bailey GW, "Relation of left atrial pathology to atrial fibrillation in mitral valvular disease", Ann Intern Med, 69, pp.13~20 (1968)
- Lin WS, "Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy", Circulation, 107, pp.3176~3183 (2003)
- Shinbane JS, "Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies", J Am Coll Cardiol, 29, pp.709~715 (1997)
- Umana E, "Tachycardia-induced cardiomyopathy", Am J Med, 114, pp.51~55 (2003)
- Stulak JM, "Left ventricular dysfunction in atrial fibrillation : restoration of sinus rhythm by the Cox-maze procedure significantly improves systolic function and functional status", Ann Thorac Surg, 82, pp.494~500 (2006)
- Nedios S, "Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: the importance of rhythm and rate control", Heart Rhythm, 11, pp.344~351 (2014)