EComment. How to maintain sinus rhythm in patients with atrial fibrillation after atrium ablation?

Abstract

I read with great interest the article by Wang et al. on the effectiveness of biatrial pacing in reducing early postoperative atrial fibrillation after the maze procedure [1]. I congratulate Wang and coworkers on their well-designed analysis and the interesting results in their publication. The most important factors to re-establish postoperative sinus rhythm in patients with long-term atrial fibrillation (AF) before cardiac surgery are dilatation of the left atrium, time of onset of AF and effectiveness and completeness of the procedure to remove the re-entry circuits in the atrium. I did not publish data on recurrence of AF after left atrium (radio)ablation in the postoperative period. My experience led me to use a loading dose of 300 mg of amiodarone intraoperative intravenous and then 900 mg intravenous 24 hours postoperatively. This was followed by 200 mg daily at discharge for 6 months. I used single or biatrial pacing according to the patient condition at completion of the surgery. This allowed me to mostly re-establish a long-term sinus rhythm postoperatively. All the factors mentioned above and the postoperative medical treatment play a role in letting the atrium restore its sinus rhythm. Conflict of interest: none declared.