Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation

Bradyarrhythmia requiring pacemaker placement is a relatively common complication after surgical ablation for atrial fibrillation (AF). We report our experience with surgical ablation procedures using various energy modalities and lesion sets in an attempt to identify the risk factors associated with postoperative pacemaker requirement.

Intraoperative data were collected prospectively, and preoperative and postoperative data were collected retrospectively. Energy modality and lesion sets used were dependent on availability on the date of the procedure and surgeon preference.

From October 1999 to October 2009, 701 patients underwent surgical ablation for AF at our institution. Forty-five patients (7.6%) required early postoperative pacemaker placement. There were no significant differences in baseline characteristics or associated procedures between patients who required pacemaker placement and those who did not. Ninety-day mortality was greater in patients requiring pacemaker placement (15.6% versus 6.6%; p = 0.025). In multivariable analysis, a pacemaker requirement was more likely with the use of microwave energy (odds ratio [OR] 2.87; confidence interval [CI], 1.41 to 5.84; p = 0.004) and a right atrial lesion set (OR, 2.82; CI, 1.07 to 7.45; p = 0.036).

In conclusion, over our 10-year experience with surgical AF ablations, the incidence of pacemaker requirement was much lower than that reported in series of classic "cut and sew" Maze procedures, even among patients undergoing full biatrial ablations. Although biatrial ablation is currently our favored approach to patients with long-standing or persistent AF, right atrial lesion sets increase the risk of this complication and should be used judiciously.