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  • Title: Atrial arrhythmia following a biatrial approach to mitral valve surgery.
    Author: Bernstein NE, Skipitaris NT, Glotzer TV, Delianides J, Chinitz LA, Colvin S.
    Journal: Pacing Clin Electrophysiol; 1996 Nov; 19(11 Pt 2):1944-6. PubMed ID: 8945074.
    Abstract:
    The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism.
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