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PubMed1986

Safety of prolonged aortic clamping with blood cardioplegia. III. Aspartate enrichment of glutamate-blood cardioplegia in energy-depleted hearts after ischemic and reperfusion injury.

This study tests the hypothesis that aspartate enrichment of glutamate-blood cardioplegia improves metabolic and functional recovery after ischemic and reperfusion damage. Ischemic and reperfusion damage were produced in 15 dogs by 45 minutes of aortic clamping at 37 degrees C and 5 minutes of blood reperfusion, before 2 more hours of aortic clamping (simulated operation). Six received multidose blood cardioplegia at 4 degrees C. In nine others, the cardioplegic solution was infused at 37 degrees C for the first 5 minutes, followed by multidose infusions at 4 degrees C. Four received 26 mmol glutamate-enriched cardioplegic solution. In five, the glutamate (13 mmol) cardioplegic solution was enriched with aspartate (13 mmol). Oxygen uptake and ventricular function (stroke work index, left atrial pressure) were measured. These data suggest aspartate enrichment produced the highest oxygen uptake (32 +/- 4 versus 17 +/- 2 ml/100 gm for glutamate and 7 +/- 1 ml/100 gm for 4 degrees C blood cardioplegia). Complete functional recovery occurred in aspartate/glutamate-treated hearts (stroke work index 90% +/- 4%, left atrial pressure 12 +/- 2 mm Hg), whereas recovery was incomplete with both glutamate alone (stroke work index 66% +/- 14%, left atrial pressure 20 +/- 3 mm Hg) and 4 degrees C blood cardioplegia at low cardiac outputs. Eight of 10 hearts not receiving aspartate failed at high cardiac outputs. Aspartate enrichment of glutamate-blood cardioplegia improves recovery after severe ischemic/reperfusion damage by improving oxidative metabolism during cardioplegic infusion and during postischemic work.

Animals↗
PubMed1996

Plasma atrial natriuretic peptide is elevated in patients with hypertrophic cardiomyopathy.

STUDY OBJECTIVES: To determine if plasma levels of atrial natriuretic peptide are elevated in patients with hypertrophic cardiomyopathy and to determine the relationship of atrial natriuretic peptide to symptoms and echocardiographic indices of left ventricular structure and diastolic function in these patients. DESIGN: A prospective study in which atrial natriuretic peptide was measured in peripheral venous plasma in 14 patients (age 44 +/- 14 years) with hypertrophic cardiomyopathy and 17 healthy controls. Echocardiography was performed in all cases and 30 controls to examine indices of left heart structure and function. All patients underwent clinical evaluation. RESULTS: The concentration of atrial natriuretic peptide was significantly higher in patients with hypertrophic cardiomyopathy than controls, (17.86 +/- 8.72 vs. 6.22 +/- 3.26 pmol/l, P = 0.0001). Diastolic dysfunction was observed in 11 of 14 patients with hypertrophic cardiomyopathy. No correlation was demonstrated between atrial natriuretic peptide levels and the degree of diastolic dysfunction, septal or free wall thickness, left atrial size, degree of mitral regurgitation or New York Heart Association functional class. CONCLUSIONS: Plasma levels of atrial natriuretic peptide are elevated in patients with hypertrophic cardiomyopathy but do not correlate with symptoms or echocardiographically-derived indices of left ventricular structure or diastolic function.

Adult↗
PubMed1987

Monitoring effects of alpha-human atrial natriuretic polypeptide (alpha-hANP) on left ventricular function in patients with essential hypertension with a cardiac probe.

The effects of alpha-hANP on left ventricular function were studied with a cardiac probe in ten patients with essential hypertension. Our data showed that intravenous administration of alpha-hANP significantly elevated left ventricular function. At 5 min, the elevation of EF, RCO, ER, RSV, PFR were 13.23% (P less than 0.02), 12.7 (P less than 0.02), 0.618 (P less than 0.02), 0.133 (P less than 0.05), 0.283 (P less than 0.01), respectively. At 10 min, the increase of EF, ER, were 11.07% (P less than 0.02) and 0.233 (P less than 0.01), respectively. Atriopeptin significantly reduced systolic and diastolic blood pressure from 2 min to 20 min (P less than 0.001-0.05).

Adult↗
PubMed1985

Noninvasive assessment of pacemaker hemodynamics by Doppler echocardiography: importance of left atrial size.

The relative decrease in cardiac output with ventricular pacing versus "physiologic" modes was measured noninvasively using Doppler echocardiography in 26 patients. Standard echocardiographic measurements of left ventricular size (diastolic diameter), left ventricular function (shortening fraction) and left atrial size were examined to determine which of these variables might best identify patients more likely to benefit from maintenance of atrioventricular (AV) synchrony. Decreases in relative cardiac output, expressed as reduction in the Doppler-derived flow velocity integral, with loss of AV synchrony ranged from 0 to 43% (mean decrease 21%). There was no correlation between left ventricular size or function and effect of pacing mode on relative cardiac output. There was, however, correlation between left atrial size and sensitivity to pacing mode. Patients with normal left atrial size were significantly more sensitive to loss of AV synchrony. In this subgroup, the decrease in flow velocity integral with ventricular pacing was 32 +/- 11% compared with only 11 +/- 13% in patients with left atrial enlargement. Thus, Doppler echocardiography is useful in assessing optimal pacing mode in the individual patient. Echocardiographically measured left atrial size may identify patients in whom physiologic pacing may be major benefit.

Adult↗
PubMed1990

[Successful surgical treatment of automatic atrial tachycardia].

A 3-year-old boy had chronic repetitive atrial tachycardia. The tachycardia could not be induced neither terminated with rapid atrial pacing nor atrial extrastimuli. Overdrive suppression and warm-up phenomenon were demonstrated. These electrophysiological features suggested atrial ectopic automaticity. Endocardial and epicardial mapping determined the origin of tachycardia at the left atrial appendage. The LA appendage was excised and the tachycardia was completely terminated. The patient is asymptomatic without medication and echocardiographic indices of left ventricular function returned to normal over 1 year follow-up period.

Child, Preschool↗
PubMed1997

[Pharmacological cardioversion of isolated atrial fibrillation: recovery of atrial mechanical function and correlation with duration of arrhythmia].

To evaluate how the duration of atrial fibrillation before cardioversion affects the recovery of atrial systolic function, serial transthoracic pulsed Doppler echocardiographic studies were performed within 2 hours and at 2 days, 7 days, 1 month and 2 months after chemical cardioversion to sinus rhythm. Peak A wave velocity (A), velocity time integral of A wave (A-VTI) and percent A-wave filling (A/VTI-tot) were assessed in 60 patients with lone atrial fibrillation of brief (> or = 12 to < or = 72 hours, 20 patients), moderate (> 72 hours to < or = 4 weeks, 20 patients) or prolonged (> 4 to < or = 24 weeks, 20 patients) duration. The three groups were well matched for age and left atrial size and none of the patients underwent antiarrhythmic therapy during follow-up. Atrial mechanical function is greater immediately and at 2 and 7 days after cardioversion in patients with brief atrial fibrillation, as compared moderate and prolonged atrial fibrillation (A and A/VTI-tot values: p < 0.05, p < 0.005 and p < 0.05, respectively). In addition, at 7 days after cardioversion, atrial systolic function is greater in patients with moderate atrial fibrillation as compared to prolonged atrial fibrillation (A value, p < 0.005 and A/VTI-tot value, p < 0.05). In all groups, atrial mechanical function increases over time and ultimately achieves similar levels. Full recovery of atrial mechanical function is achieved within 2 days in patients with brief atrial fibrillation, within 7 days in patients with atrial fibrillation of moderate duration and within 1 month in patients with prolonged atrial fibrillation. Recovery of the mechanical function of the left atrium is related to the duration of atrial fibrillation before cardioversion. These findings have important implications for assessing the early hemodynamic benefits of successful cardioversion.

Adult↗
PubMed1996

Surgery for atrial fibrillation.

OBJECTIVE: The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. METHODS: In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. RESULTS: In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 44%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P < 0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P < 0.001). Restoration of the right atrial function raised the cardiac index from 2.25 +/- 0.55 1/min per m2 during atrial fibrillation to 2.54 +/- 0.58 1/min per m2, with a mean percentage increase in cardiac index of 13.5% (P < 0.00018). Atrial partitioning ("maze operation") was performed on five patients with an immediate sinus rhythm recovery of 100%, but with two patients requiring pacemaker implant. Seven out of eight patients (87.5%), with atrial fibrillation secondary to atrial septal defect, who underwent surgical isolation of the right atrium at the time of surgery were free from atrial fibrillation and without medications. 2-52 months after operation. Thirteen of 14 patients with "lone" atrial fibrillation who underwent corridor procedure remained in sinus rhythm with a sinus rhythm recovery rate of 92%. CONCLUSIONS: Different surgical options can be chosen for different cases of atrial fibrillation, according to the underlying cardiac disease.

Adult↗
PubMed2003

Doppler tissue imaging to assess systolic function in Chagas' disease.

OBJECTIVE: To assess the usefulness of Doppler tissue imaging (DTI) for evaluating the systolic function of chagasic patients with and without electrocardiographic abnormalities, in comparision with echocardiographic study. METHODS: We studied 77 patients divided into 3 groups as follows: group 1 - control; group 2 - chagasic patients with normal electrocardiographic findings; and group 3 - chagasic patients with abnormal electrocardiographic findings. The following parameters were assessed: left ventricular dimensions and ejection fraction, left atrial dimensions and diastolic function on echocardiography. Systolic velocity and regional isovolumic contraction time (IVCTr) of the septal, anterior, lateral, posterior and inferior left ventricular walls were assessed on DTI. RESULTS: Left ventricular cavitary dimensions, ejection fraction and DTI systolic wave showed significant differences between groups 1 and 3 and between groups 2 and 3, which were not found between groups 1 and 2. IVCTr allowed a statistically significant discrimination among the 3 groups. CONCLUSION: DTI allowed discrimination among the different groups assessed, being superior to echocardiography in identifying early abnormalities of contractility, and, therefore, potentially useful for detecting incipient myocardial alterations in chagasic patients with normal electrocardiographic findings.

Adult↗
PubMed1989

[Correlations of ECG ST segment changes and indicators of left ventricular function in patients with unstable stenocardia during the atrial stimulation test].

Thirty patients with unstable angina pectoris underwent atrial stimulation test under continuous ECG monitoring and repeat coronary ventriculography. All this made it possible to compare ST-segment dynamics with altered parameters of left ventricular contractility in induced myocardial ischemia. It was shown that ischemia that appeared as ST-segment depression caused abnormal regional myocardial contractility in the area of impaired coronary blood flow. At the same time, ischemias shown by ST-segment elevation resulted in abnormal diastolic myocardial relaxation in the left ventricle.

Adult↗
PubMed2005

Impact of sinus rhythm restoration and maintenance on left ventricular function and exercise tolerance in patients with persistent atrial fibrillation.

BACKGROUND: Although early improvement of haemodynamic parameters following successful cardioversion of atrial fibrillation (AF) has been well documented, the long-term benefits of sinus rhythm (SR) restoration are less obvious, mainly due to a high rate of AF relapses. AIM: To determine the impact of SR restoration and maintenance on exercise tolerance and heart failure progression in patients with persistent non-valvular AF during a one year follow-up period. METHODS AND RESULTS: We studied 104 patients (33 females, 71 males, mean age 60.4+/-7.4 years) with mild to moderate stable heart failure and persistent AF with well-controlled ventricular rate who were scheduled for cardioversion. They underwent submaximal exercise testing 24 hours before cardioversion, as well as 1 and 12 months afterwards. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol. Heart failure symptoms were assessed at the same time-points of follow-up. RESULTS: SR was presented in 66 (63.5%) patients one year after cardioversion. In patients with SR, a significant improvement in left ventricular (LV) performance, exercise capacity and heart failure symptoms was noted. There was an increase in LV fractional shortening (29.9+/-7.6% vs 35.6+/-9.3%; p<0.001), maximal workload (4.7+/-2.3 vs 8.5+/-3.0 MET; p<0.001), exercise duration (125.3+/-115.3 vs 294.7+/-216.7 sec.; p<0.001), and improvement in the NYHA functional class (p<0.001). No such changes were observed in patients who had AF relapse during follow-up or in those who had unsuccessful cardioversion. CONCLUSIONS: Successful cardioversion of persistent AF resulted in a significant improvement of exercise capacity and a decrease in heart failure symptoms during one year follow-up period only in patients who maintained SR.

Aged↗
PubMed2001

Natriuretic peptides in patients with aortic stenosis.

BACKGROUND: Whereas atrial natriuretic peptide (ANP) is secreted mainly from cardiac atria, brain natriuretic peptide (BNP) is produced to a larger extent in ventricles. Their relative importance as markers of cardiac function and myocardial hypertrophy is not yet clarified. This study evaluated circulating BNP and ANP and the N-terminal part of their propeptides (NT-proBNP and NT-proANP) as markers of left ventricular hypertrophy and atrial pressure increase in patients with aortic stenosis. METHODS: The plasma concentrations of BNP, NT-proBNP, ANP, and NT-proANP were measured by radioimmunoassay in 67 patients with aortic stenosis. Peptide plasma concentrations were related to measurements obtained by cardiac catheterization and echocardiography. RESULTS: Receiver operating characteristic curves indicated that BNP and NT-proBNP performed best in the detection of increased left ventricular mass and NT-proANP in the detection of increased left atrial pressure. NT-proBNP was significantly increased in mild left ventricular hypertrophy (left ventricular mass index, 78 to 139 g/m(2)), whereas NT-proANP was not increased until left ventricular mass index was 141 to 180 g/m(2). CONCLUSIONS: Plasma BNP and NT-proBNP may serve as early markers of left ventricular hypertrophy, whereas ANP and NT-proANP reflect left atrial pressure increase. The repeated and combined measurements of natriuretic peptides might provide diagnostic information relevant to the evaluation of the stage of aortic stenosis.

Adult↗
PubMedDate not supplied

Non-invasive methods of atrial function evaluation in heart diseases.

The article describes four essential components (hemodynamic, bioelectrical, hormonal, metabolic) of atrial function. The role atria play in heart hemodynamic performance by virtue of their reservoir, conduit and active contractile function is emphasized. Next, the authors relate various non-invasive diagnostic methods in cardiology to the estimation of particular types of atrial function in physiological and in selected pathological conditions. Only non-invasive and easy accessible in clinical practice diagnostic methods are presented. The use of echocardiography for the evaluation of hemodynamic function of atria and left atrial appendage is particularly exposed.

Atrial Natriuretic Factor↗
PubMed1982

Effects of verapamil on positive inotropic stimulation in the left atrium and ventricle of conscious dogs.

The interaction of verapamil with three known positive inotropic stimuli, ouabain, dopamine and postextrasystolic potentiation (PESP), was studied in 10 conscious dogs. Implanted sonomicrometer crystals and solid state pressure transducers were used to evaluate left atrial (LA) and left ventricular (LV) function while heart rate was held constant by atrial pacing. Ouabain (0.025 mg/kg) and dopamine (3-5 micrograms/kg/min) were administered in amounts sufficient to increase LV dP/dt by about 20%. PESP was achieved by using a programmed stimulator to introduce atrial premature beats. Each of these inotropic interventions caused significant (P less than .05) increases in LV dp/dt, LV fractional shortening, LA fractional shortening LV-velocity of circumferential fiber shortening (Vcf) and LA-Vcf. Administration of a single i.v. dose of verapamil (0.03 mg/kg) caused no change in base-line mechanical and hemodynamic parameters. However, when verapamil was given during the increased inotropic state resulting from ouabain or dopamine administration, significant (P less than .05) decreases occurred in LV dP/dt, LV fractional shortening, LA fractional shortening, LV-Vcf and LA-VCf. Verapamil did not alter the positive inotropic response to PESP in the LV or LA. Thus, a dose of verapamil that did not change resting indices of myocardial contractility depressed function significantly during positive inotropic responses to ouabain and dopamine. This negative inotropic effect seemed to be selective because verapamil did not alter the response to PESP.

Animals↗
PubMed1993

Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling.

Previous studies have shown regional differences in atrial distensibility. We studied 12 open-chest dogs to test the hypothesis that left atrial compliance is decreased after removal of the left atrial appendage and to determine the effect of altered atrial compliance on atrial reservoir and conduit function. Sonomicrometer crystal pairs were used to measure the long- and short-axis diameters of the left atrium over a wide range of intracardiac pressures and volumes obtained by intravenous hetastarch infusion both before and after suture ligation of the left atrial appendage (appendectomy). Pulmonary venous flow was measured with an ultrasonic flowmeter, and transmitral flow velocities were measured with transesophageal Doppler echocardiography. After appendectomy, the diastolic pressure-volume relation was shifted upward and to the left in six of seven dogs. The mean dynamic stiffness constant of the left atrial diastolic pressure-volume relation was significantly greater after appendectomy than before (0.20 +/- 0.11 [mean +/- SD] versus 0.14 +/- 0.08 ml-1, p < 0.01); the mean y intercept was slightly, but significantly, less after appendectomy (0.6 +/- 0.3 versus 1.3 +/- 0.6 mm Hg, p < 0.05). The left atrial reservoir volume (maximum minus minimum left atrial volume) was significantly less after appendectomy at matched left atrial pressures. The systolic to diastolic flow integral ratio of pulmonary venous flow (JFTI/KFTI), an index of the relative reservoir to conduit functions of the left atrium, increased significantly with volume infusion only before appendectomy; at matched left atrial pressure, JFTI/KFTI was significantly less afterwards.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

[Cardiovascular ultrasound: applications for the assessment of cardiac function].

Congestive heart failure(CHF) is usually associated with impaired left ventricular(LV) systolic function, and thus, the measurement of systolic function is an essential component of the evaluation of any patients with known or suspected cardiac disease. Among many parameters, most frequently used are LV percent fractional shortening and ejection fraction(EF), which can be easily measured from an M-mode echocardiogram. However, these M-mode measurements may be inaccurate in patients with asymmetrical LV due to myocardial infarction, right ventricular overload or sigmoid septum. Especially in such cases, EF should be measured using two-dimensional echocardiography. Usually, LV volumes and EF are calculated using the disc-summation method through the manual tracing of apical two-chamber and four-chamber echocardiograms. On the other hand, it has been recognized that congestive heart failure may arise in the absence of any systolic dysfunction and CHF due to systolic dysfunction never occurs in the absence of concomitant diastolic dysfunction. Although the analysis of pulsed-Doppler transmitral flow velocity has been most widely used for the noninvasive assessment of LV diastolic function, an increase in left atrial pressure during CHF can pseudonormalize an abnormal flow pattern and mask LV diastolic dysfunction. Recently, we proposed a new index for assessing LV diastolic function, flow propagation velocity, which can be measured with color M-mode Doppler echocardiography and baseline-shift technique. Recent studies have shown that the flow propagation velocity is a unique noninvasive parameter of LV diastolic function which can accurately detect the diastolic impairment in patients with different types of cardiac diseases with various loading conditions.

Diastole↗
PubMed2004

Plasma N-terminal pro-brain natriuretic peptide: a marker of left ventricular hypertrophy in hypertrophic cardiomyopathy.

BACKGROUND: B-type natriuretic peptide is secreted mainly in the left ventricle in response to elevated wall tension. Plasma levels of the peptide correlate positively with cardiac filling pressures, making it an excellent marker for the presence of left ventricular dysfunction. In hypertrophic cardiomyopathy, enhanced production of B-type natriuretic peptide is observed. However, the relationship of the various structural and functional features present in the disease with the high plasma levels described is not yet fully clarified. In the present study, we prospectively assessed in hypertrophic cardiomyopathy the relationship of plasma NT-proBNP levels with the extent of left ventricular hypertrophy, presence of left ventricular outflow obstruction and echocardiographic parameters of left ventricular diastolic function. METHODS: The study population included 190 individuals: 53 patients with hypertrophic cardiomyopathy and well-preserved left ventricular systolic function (group A), 92 healthy relatives with no disease expression (group B), and an additional group of 46 healthy volunteers (group C) as controls for NT-proBNP levels. Groups A and B were characterized clinically and by echocardiography and compared with each other. Plasma NT-proBNP levels were measured (ECLIA-Elecsys proBNP) and compared in the 3 groups of individuals included in the study. In hypertrophic cardiomyopathy patients, correlation was sought between NT-proBNP levels, NYHA functional class and echocardiographic data. RESULTS: Groups A and B differed (p < 0.001) in septal thickness, maximal wall thickness, left ventricular hypertrophy score, left atrial size, left atrial fractional shortening, derived transmitral filling indices and plasma NT-proBNP levels (group A: 909.9 +/- 1554.2 pg/ml; group B: 40.7 +/- 45.1 pg/ml). Left ventricular diastolic size and pulmonary venous flow velocity-derived indices were similar in the 2 groups. NT-proBNP levels in group B and C (39.4 +/- 34.5 pg/ml) were similar (p = NS). In hypertrophic cardiomyopathy patients, NT-proBNP levels correlate directly with NYHA functional class (r = 0.56, p < 0.001), septal thickness (r = 0.53, p < 0.001), maximal wall thickness (r = 0.59, p < 0.001), left ventricular hypertrophy score (r = 0.63, p < 0.001), left atrial size (r = 0.32, p = 0.023) and mitral deceleration time (r = 0.46, p = 0.001) and inversely with left atrial fractional shortening (r = -0.41, p = 0.005). Functional class also correlates directly with left ventricular hypertrophy score (r = 0.39, p = 0.006), with the most symptomatic patients having the highest scores. CONCLUSIONS: In hypertrophic cardiomyopathy, plasma NT-proBNP levels depend mainly on the severity of left ventricular hypertrophy rather than on the presence of obstruction. Measurement of the peptide may help in the clinical characterization and follow-up of patients with this disease.

Adolescent↗
PubMed2005

Endocardial radiofrequency ablation during mitral valve surgery: effect on cardiac rhythm, atrial size, and function.

BACKGROUND: Restoration of sinus rhythm is thought to lead to a reduction in left atrial size and to recovery of atrial contraction. We aimed to investigate changes in atrial size and function in patients undergoing radiofrequency ablation for atrial fibrillation during mitral valve surgery. METHODS: In a prospective study, 70 patients (64 +/- 10 years) with mitral valve disease and atrial fibrillation underwent mitral surgery and left atrial endocardial radiofrequency ablation. Evaluation was achieved before surgery, at 7 days, 5 months, and 22 months after surgery. Maximal right and left atrial areas, left atrial diameter, and volume were measured. Atrial filling fraction (ventricular filling related to atrial contraction to total ventricular filling ratio) was used as an index of atrial contraction. RESULTS: At the end of follow-up (22 +/- 10 months) most patients (91%) were in sinus rhythm. Actuarial freedom from atrial fibrillation recurrence was 62.5% after 2 years. Atrial size decreased, with a significant improvement in right (36 +/- 15 vs 10 +/- 20% preoperatively, p < 0.0001) and left (25 +/- 12 vs 7 +/- 14%, p < 0.0001) atrial filling fraction. Despite similar preoperative atrial size, at the end of follow-up atrial fibrillation recurrence was associated with a higher left atrial volume than in patients free of recurrence (41 +/- 14 vs 32 +/- 9 mL/m2, p = 0.004). Independent predictors of atrial fibrillation recurrence were previous mitral procedure (p = 0.029), left ventricular ejection fraction (p = 0.033), and mitral rheumatic lesion (p = 0.034). CONCLUSIONS: Left atrial radiofrequency ablation for atrial fibrillation during mitral surgery is an effective procedure restoring sinus rhythm. Right and left atrial size was significantly reduced, with a recovery in atrial contraction.

Adult↗