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.
