A new procedure for elimination of atrial fibrillation associated with mitral valve disease: a proof-of-concept study

BACKGROUND: Left atrial enlargement and fibrosis have been linked to the pathogenesis of atrial fibrillation (AF). The authors aimed to introduce a novel concept and develop a new procedure for AF treatment based on these characteristics. METHODS: The study included three stages. The first stage was a descriptive study to clarify the characteristics of the left atrial enlargement and fibrosis’ distribution in patients with mitral valve disease and long-standing persistent AF. Based on these characteristics, the authors introduced a novel concept for AF treatment, and then translated it into a new procedure. The second stage was a proof-of-concept study with this new procedure. The third stage was a comparative effectiveness research to compare the clinical outcomes between patients with this new procedure and those who received Cox-Maze IV treatment. RESULTS: Based on the nonuniform fashion of left atrial enlargement and fibrosis’ distribution, the authors introduced a novel concept: reconstructing a left atrium with appropriate geometry and uniform fibrosis’ distribution for proper cardiac conduction, and translated it into a new procedure: left atrial geometric volume reduction combined with left appendage base closure. As compared to the Cox-Maze IV procedure, the new procedure spent significantly shorter total surgery time, cardiopulmonary bypass time, and aortic cross-clamp time (P<0.001). Besides, the new procedure was related to a shorter ICU stay period (odd ratio (OR)=0.45, 95% CI=0.26–0.78), lower costs (OR=0.15, 95% CI=0.08–0.29), and a higher rate of A wave of transmitral and transtricuspid flow reappearance (OR=1.76, 95% CI=1.02–3.04). CONCLUSIONS: The new procedure is safe and effective for eliminating AF associated with mitral valve disease.