Ablation and Left Atrium Reduction During Mitral Valve Surgery for Atrial Fibrillation
Ablation and Left Atrium Reduction During Mitral Valve Surgery for Atrial Fibrillation
The purpose of this study is to estimate left atrial volume reduction surgery concomitant
 with the maze procedure and mitral valve repair/replacement in patients with atrial
 fibrillation with an enlarged left atria.
The Cox-Maze procedure has been a gold standard for the treatment of atrial fibrillation.
 Success of the modified maze procedure after valvular operation with an enlarged left atria
 and persistent and longstanding persistent atrial fibrillation remains suboptimal. The
 question addressed was: In adults undergoing a maze procedure for atrial fibrillation does
 left atrial size reduction compared to maze surgery alone improve maze surgery success?
Inclusion Criteria:

 -  Able to sign Informed Consent and Release of Medical Information forms

 -  Age ≥ 18 years

 -  Clinical indications for mitral valve surgery for organic mitral valve disease Note:
 May include need for surgical management of functional tricuspid regurgitation or
 patent foramen ovale. Surgical intervention may be performed via sternotomy or
 minimally invasive procedure.

 -  a) Persistent atrial fibrillation (AF) within 6 months prior to randomization, defined
 as non self-terminating AF lasting greater than 7 days but no more than one year, or
 lasting less than 7 days but necessitating pharmacologic or electrical cardioversion.

 Duration of AF must be documented by medical history and Presence of AF must be documented
 by a direct electrocardiographic assessment within 6 months prior to randomization.

 b) Longstanding persistent AF is defined as continuous AF of greater than one year
 duration.

 Duration of AF must be documented by medical history and Presence of AF must be documented
 by a direct electrocardiographic assessment upon arrival in the OR.

 -  left atrial diameter > 65mm

 -  Able to use heart rhythm monitor

 Exclusion Criteria:

 -  AF is paroxysmal

 -  AF without indication for mitral valve surgery

 -  Concomitant coronary artery bypass grafting (CABG), aortic arch or aortic valve
 procedure

 -  Previous catheter ablation for AF

 -  Redo cardiac surgery

 -  Left ventricle ejection fraction (LV EF) < 35%

 -  Life expectancy of less than one year

 -  Mental impairment or other conditions that may not allow subject to understand the
 nature, significance, and scope of study