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European Heart Journal Advance Access published online on November 5, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm378
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)

Carina Blomström Lundqvist1,*, Birgitta Johansson2, Eva Berglin3, Leif Nilsson4, Steen M. Jensen5, Stefan Thelin4, Anders Holmgren6, Nils Edvardsson2, Göran Källner7 and Per Blomström1

1 Department of Cardiology, Uppsala University Hospital, SE-75185 Uppsala, Sweden
2 Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
3 Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
4 Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden
5 Department of Cardiology, Umeå University Hospital, Umeå, Sweden
6 Department of Cardiothoracic Surgery, Umeå University Hospital, Umeå, Sweden
7 Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

* Corresponding author. Tel: + 46 611 3113; fax: +46 18 510243. E-mail address: carina.blomstrom.lundqvist{at}akademiska.se

Aims: The efficacy of epicardial left atrial (LA) cryoablation in eliminating atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) is unknown. We hypothesized that MVS combined with LA cryoablation is superior to MVS alone.

Methods and results: Sixty-nine patients with permanent AF, included at four centres, underwent MVS with or without epicardial LA cryoablation. The primary endpoint was regained sinus rhythm. Risk factors for failed AF cryoablation were elucidated.

Sixty-five out of 69 patients reached the primary endpoint. At 6 and 12 months follow-up, 73.3% of patients who underwent cryoablation had regained sinus rhythm at both follow-ups, compared with 45.7 and 42.9% of patients, respectively, who underwent MVS alone (group differences, at 6 months P = 0.024, after 12 months P = 0.013). The in-hospital complication rate was 11.4% in the MVS group and 26.5% in the cryoablation group (P = 0.110). Risk factors for failed elimination of AF by cryoablation were duration of permanent AF (P = 0.012) and presence of coronary artery disease (P = 0.047), according to multiple logistic regression analysis.

Conclusion: This first prospective randomized study showed that combining MVS with epicardial LA cryoablation is significantly better in eliminating pre-operative permanent AF than MVS alone.

Key Words: Ablation • Fibrillation • Mitral valve


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