Late results of permanent atrial fibrillation ablation surgery in aortic valve and CABG patients

Objective: Long-term results of combined permanent atrial fibrillation (pAF) ablation and coronary artery bypass grafting (CABG) and/or aortic valve (AV) surgery are unknown. This study analyzes the pAF ablation results concomitant to CABG and/or AV surgery and describes factors that deteriorate the chance to establish stable sinus rhythm (SR).

Methods: Seventy-four patients (age 73±7 years) with pAF for 0.5–30 years underwent either bipolar (n=54) or monopolar (n=20) radiofrequency (RF) ablation procedures concomitant to CABG and/or AV surgery (CABG: n=36, AV: n=29, AV+CABG: n=9). All patients were restudied to assess survival, New York Heart Association (NYHA) class and SR conversion rate 29±15 months after surgery.

Results: Survival was 96% (total deaths: n=3). NYHA class improved significantly after surgery, particularly when stable SR (77% of patients) was achieved (from 3.0±0.1 to 1.2±0.4, p<0.05). Neither etiology of the underlying heart disease nor application modus of RF energy (mono- vs. bipolar) affected the SR conversion rate significantly. Risk factors for pAF recurrence were an enlarged size of the left atrium (LA) and long-time duration of pAF before surgery (Table).

	LA size <50mm	LA size ≥50mm	pAF duration <5 years	pAF duration ≥5 years	Total
Number of pts., n	41	30	39	32	71
AF at follow-up, %	17	30	13	34	23
SR at follow-up, %	83	70	87	66	77
P-value	<0.05		<0.05		-

Conclusion: Established SR improves functional class after combined pAF and CABG and/or AV surgery; LA size and pAF duration significantly influence the success of ablation surgery.