Objectives: Endocardial Microwave ablation (MW) is accepted as an effective and safe concomitant
procedure for the treatment of permanent atrial fibrillation (pAF). Epicardial MW
is an alternative for patients, where opening of the left atrium is not required.
Spontaneous conversion after surgery to sinus rhythm is rare. We compared the follow-up
of patients with pAF who had comparable cardiac operations with and without MW (endo-
and epicardial) in a retrospective study.
Methods: Data of 136 patients were analyzed. In Group A (endocardial) and Group B (epicardial)
CABG and/or aortic valve replacement was performed with concomitant ablation. In group
C equivalent procedures were done without ablation. Preoperative data like age, ejection
fraction left atrial diameter and duration of pAF were comparable. No antiarrhythmic
drugs were given postoperatively, except standard beta-blocker therapy.
Results: We had no ablation related complications. Additional operation time for ablation
was 13min.
|
|
group A (n=45)
|
group B (n=40)
|
group C (n=51)
|
|
sinus rhythm after one year
|
75
|
66
|
9.6
|
|
30 day survival
|
98
|
97.5
|
95.9
|
|
one year survival
|
90.4
|
92.1
|
85.8
|
Conclusion: Our results underline the high value of MW to restore sinus rhythm in patients with
pAF. The reduction of surgical trauma (epicardial approach) does not lead to a significant
decrease of the conversion rate to sinus rhythm. Therefore we conclude that the epicardial
approach can be advocated justified for patients with pAF, who require CABG and/or
aortic valve replacement.
