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Introduction The cornerstone of catheter ablation for atrial fibrillation (AF) is pulmonary vein electrical isolation (PVI). Recurrent AF post-PVI is a major limitation of the procedure with PV reconnection present in most patients. Single (SLT) and double (DLT) lung transplant surgery involves a 'cut and sew' PV antral isolation analogous to a catheter-based approach providing an opportunity to assess the efficacy of durable PVI. Methods and results A total of three hundred and twenty-seven consecutive lung transplant patients were compared with 201 control non-transplant thoracic surgery (THR) patients between 1998 and 2008. The primary analysis was the incidence of 'early' post-operative AF and 'late' AF (AF occurring following discharge from hospital after the index operation). Risk factors for the development of late AF were analysed using regression analysis. Acute post-operative AF was more common post-lung transplant (DLT 58/200 (29%) and SLT 36/127 (28%) vs. THR 28/201 (13.9%), P < 0.001) occurring at 4.7 +/- 5.0 days in DLT, 3.4 +/- 2.5 days after SLT, and 7.4 +/- 11.2 days in the thoracic group (P < 0.001). At a mean follow-up of 5.4 +/- 2.9 years late AF occurred in 1/200 (0.5%) in DLT vs. 16/127 (12.6%) in SLT and 23/201 (11.4%, P < 0.001) in THR groups. Kaplan-Meier survival analysis demonstrated the association of DLT with long-term freedom from AF. Significant variables [hazard ratio (HR) on univariate regression analysis fo late AF were: DLT 0.06, age 1.09, LA diameter 1.2, hypertension 3.0, preoperative AF 12.2, early AF 8.8, rejection 3.2]. Conclusion Double but not SLT provides long-term freedom from AF despite a similar early post-operative incidence. This supports the critical role of the pulmonary veins in the pathogenesis of atrial fibrillation and the importance of durable electrical isolation of the pulmonary veins as the cornerstone in strategies for the long-term prevention of AF.
Department of Cardiology, The Melbourne Royal Melbourne Hospital, University of Melbourne, 3004 Melbourne, Australia.
This article was published in the following journal.
Name: European heart journal
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Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).
Absence of air in the entire or part of a lung, such as an incompletely inflated neonate lung or a collapsed adult lung. Pulmonary atelectasis can be caused by airway obstruction, lung compression, fibrotic contraction, or other factors.
A diverse group of lung diseases that affect the lung parenchyma. They are characterized by an initial inflammation of PULMONARY ALVEOLI that extends to the interstitium and beyond leading to diffuse PULMONARY FIBROSIS. Interstitial lung diseases are classified by their etiology (known or unknown causes), and radiological-pathological features.
A lung with reduced markings on its chest radiograph and increased areas of transradiancy (hyperlucency). A hyperlucent lung is usually associated with pulmonary emphysema or PNEUMOTHORAX.
A cardiotonic glycoside obtained mainly from Digitalis lanata; it consists of three sugars and the aglycone DIGOXIGENIN. Digoxin has positive inotropic and negative chronotropic activity. It is used to control ventricular rate in ATRIAL FIBRILLATION and in the management of congestive heart failure with atrial fibrillation. Its use in congestive heart failure and sinus rhythm is less certain. The margin between toxic and therapeutic doses is small. (From Martindale, The Extra Pharmacopoeia, 30th ed, p666)
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