Cor Vasa 2015, 57(4):e323-e328 | DOI: 10.1016/j.crvasa.2015.03.003

Surgical ablation for atrial fibrillation as a concomitant cardiac surgery procedure. A single-centre study with 1-year follow-up

Lukáš Mach^a, Vladimír Horváth^a,b, Eva Jakubcová^a, Katarína Kovačičová^c, Zdenko Kasáč^c, Petr Němec^a,b, Tomáš Konečný^a,d, Marek Orban^a,b,*

^a Mezinárodní centrum klinického výzkumu - Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

^b Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

^c Masarykova univerzita, Brno, Česká republika

^d Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA

Introduction: Surgical ablation procedures have been shown to be effective in treatment of atrial fibrillation (AF), but convincing evidence showing relationship between clinical confounders, surgical technique and intermediate-to-long term outcomes is still lacking. Therefore we conducted a retrospective single-centre database study to identify predictors of sinus rhythm (SR) maintenance at 12 months after surgery with insights into standard medical care provided by general practitioners and/or outpatient cardiologists in the setting of a newly introduced method.

Methods: Data from consecutive 376 patients, who underwent heart surgery which included surgical left atrial (LA) ablation for AF between July 2006 and December 2010, were collected. Primary outcome was maintenance of SR at 12 months. A stepwise backward multivariate logistic regression analysis was used to identify predictors of the primary outcome.

Results: RF ablation was performed in 210 patients and 166 patients underwent cryoablation. In 273 subjects the 12-month follow-up data were available. The success rate in maintaining the sinus rhythm 1 year after surgery was 48.9% (63.1% for cryoablation, and 37.8% for RF [p < 0.0001]). None of the patients underwent repeated ablation procedure within the 12-month follow-up period. Paroxysmal AF, mitral valve surgery, and smaller LA diameter were associated with the primary endpoint; cryoablation was superior to RF ablation. Nevertheless, prescription rate of amiodarone/propafenone in patients with documented sinus rhythm at 12-month follow-up was 36.0%.

Conclusions: Using multivariate analysis of retrospective data we identified clinical confounders and technical aspects associated with better outcomes after surgical ablation for AF.

Keywords: Atrial fibrillation; Surgical ablation

Received: February 24, 2015; Revised: March 3, 2015; Accepted: March 4, 2015; Published: August 1, 2015  Show citation