CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 3, May/June 2010
AFRICA
139
Anti-arrhythmic prophylaxis was carried out on a routine
basis. Amiodarone was used as the first drug of choice: an
intravenous bolus of 300 mg, followed by a continuous infusion
of 1 200 mg/24 hours was routinely administered until the first
postoperative day. In the absence of AV block other than first
degree or in the absence of unstable SR, oral administration of
200 mg amiodarone three times a day was given until discharge.
A maintenance regimen of 200 mg/day was given for three to
six months.
In cases of contraindications to amiodarone, sotalol or propa-
fenone were given. Sotalol plus amiodarone, or electromechani-
cal cardioversion was performed in patients with relapsing AF
during hospitalisation. Monitoring with standard 12-lead electro-
cardiography, Holter ECG and transthoracic echocardiography
was done one, three, six and 12 months after the operation.
Statistical analysis
SPSS (Statistical Package for Social Sciences) for Windows
version 10.0 was used for the analysis of data. Besides descrip-
tive statistics (mean
±
standard deviation), the Student’s
t
-test
and Mann-Whitney U-test were used for the comparison of
quantitative data. For the comparison of qualitative data, the
Chi-square, Fischer’s Exact Chi-square and Mc Nemar tests were
used. Result were evaluated at 95% confidence intervals and at a
significance level of
p
<
0.05.
Results
Hospital mortality was 6.3% (six patients): five due to low
cardiac output and one due to pulmonary complications. No
morbidity related to the ablation procedure itself was observed.
Seven patients had pulmonary complications (7.6%) and nine
(10.1%) stayed in the intensive care unit for more than 48 hours.
Mean durations of intubation and hospitalisation were 12.27
±
4.78 hours and 8.7
±
5.83 days, respectively. No neurological
event was observed.
On arrival in the intensive care unit after the operation, 74
patients (77.9%) were in normal sinus rhythm, 15 (15.8 %)
were in AF, and six (6.3%) were in AV block. Among the six
patients who died in hospital, two of them were in sinus rhythm,
two in complete AV block and two in AF. Among the remaining
four patients with complete AV block on arrival in the intensive
care unit, one developed AF and three resumed normal sinus
rhythm.
Sixteen of the patients with normal sinus rhythm on arrival in
the intensive care unit relapsed into AF during hospitalisation.
Medical treatment with amiodarone and sotalol resumed normal
sinus rhythm in five patients, and electromechanical cardiover-
sion resumed normal sinus rhythm in one of these 16 patients.
When the 89 surviving patients were discharged, 65 (65/89,
73%) were in normal sinus rhythm and 24 were in AF (24/89,
27%).
None of the patients required permanent pacemaker implan-
tation during the follow-up period. Of the 89 patients who were
discharged, follow up was performed in all at one month, in
81 at three months, in 76 at six months and in 73 at 12 months
post surgery (Fig. 2). Unfortunately, the socio-economic and
geographical characteristics of our country prevented 100%
follow up of the patients.
According to the parameters reviewed at six months postop-
eratively, patients with atrial fibrillation and sinus rhythm did
not differ in terms of left atrial diameter, left ventricular end-
diastolic and end-systolic diameter, ejection fraction, pulmonary
artery pressure and left ventricular end-diastolic pressure. When
the subgroup of patients operated for mitral stenosis was exam-
ined, patients with AF and sinus rhythm were similar with regard
to mitral valve area and maximum gradients (
p
>
0.05) (Tables
2, 3).
Pre-operative functional capacity, type and aetiology of the
mitral valve lesion, presence of coronary artery disease, ablation
technique, presence of hypertension or the type of mitral inter-
vention (replacement or repair) did not affect the success of the
ablation procedures (Table 4).
Discussion
Most patients with persistent AF have underlying cardiovascular
disease and are candidates for open-heart surgery. These patients
are prone to develop thromboembolic complications and their
cardiac performance is worse than patients with normal sinus
rhythm. In more than 80% of patients with mitral valve disease
TABLE 2. DISTRIBUTION OFAF CASES BY
DEMOGRAPHIC PROPERTIES
Holter-ECG at 6 months
Test statistics
NSR (
n
=
59)
(mean
±
SD)
AF (
n
=
17)
(mean
±
SD)
Age
60.12
±
8.23 55.07
±
12.34
t
: 1.555;
p
: 0.125
BMI
22.99
±
6.57 25.58
±
5.11
t
: –1.539;
p
: 0.130
Gender
n
% n
%
Female
44 70.5 14 82.4
χ
2
: 0.897;
p
: 0.344
Male
15 29.5 3 17.6
NSR: normal sinus rhythm; AF: atrial fibrillation;
t
: Student’s
t
-test
statistics;
χ
2
: Chi-square statistics; BMI: body mass index.
Fig. 2. The course of cardiac rhythm during hospitalisa-
tion and follow up.
Atrial fibrillation Block
Normal sinus rhythm
100
90
80
70
60
50
40
30
20
10
0
End of
oper-
ation
Dis-
charge
1
Month
3
Months
6
Months
12
Months
Patients (%)
