Concomitant procedure of atrial fibrillation ablation with and without left atrioplasty during surgical correction of the mitral valve disease: prospective, randomized trial

Objective. Main objective of this prospective randomized study was to assess safety and efficiency of the combined approach for the left atrial ablation in combination with and without reduction left atrioplasty in patients with mitral valve disease.Material and Methods. The study was performed from September, 2014 to February, 2017. A total of 120 patients with mitral valve disease, permanent atrial fibrillation (AF), and left atriomegaly were enrolled in the study. Patients were randomized to two groups: group I comprised patients who received correction of mitral valve disease in combination with AF ablation and without reduction atrioplasty of the left atrium (MV+MAZE); group II (n=60) comprised patients with correction of mitral valve disease in combination with AF ablation and with reduction atrioplasty of the left atrium (MV+MAZE+AP). Patient characteristics did not differ between groups.Results. There were no significant differences between groups in the early mortality rates (2 patients in group I versus 5 patients in group II, p=0.64); bleeding rates (total 5 cases including 2 patients in group I and 3 patients in group II, p=0.34), and the rates of AF recurrence in the early postoperative period. Permanent pacemakers were implanted in 8 patients (13.3%) of group I and in 4 patients (6.7%) of group II. Total long-term mortality was 4 patients including 1 and 3 patients in group I and II, respectively, which did not significantly differed. The rates of one-year freedom from AF were 84.8 and 86.2% in group I and II, respectively. No new onsets of atrial fibrillation were observed for 36 months in both groups. The rates of freedom from thromboembolic events during the time of observation were 88.6% in group I and 96.5% in group II. Conclusion. The left atrial reduction concomitant with the left atrial ablation and correction of mitral valve disease is safe and effective procedure. However, this procedure did not impact the rates of long-term freedom from AF.