The surgical treatment of concomitant atrial arrhythmias during redo cardiac operations

With improving surgical care yielding better outcomes, patients who have undergone a cardiac operation are surviving longer, and surgeons will inevitably face an increasing number of reoperative procedures. There are few data reporting risk and outcome for patients undergoing atrial fibrillation ablation in this clinical setting.

From January 1994 through May 2009, we performed surgery for AF in 245 patients (134 female) who have had at least1 prior cardiac operation. Median age was 45 years (range 1 to 75 years) and preoperative atrial fibrillation was paroxysmal in 161 patients (66%). Most common cardiac diagnoses included Ebstein anomaly (n=43), tetralogy of Fallot (n=36), and acquired valvular or ischemic heart disease (n=35). Median prior sternotomies was 1 (range 1 to 6).

Ablative lesions most commonly included isolated right-sided maze (n=123; cryothermy in 84, cut and sew in 39), biatrial maze (n=52; cryothermy in 26, cut and sew in 26), and right atrial isthmus ablation (n=41; isolated in 30, concomitant in 11). There were 14 early deaths (5.7%). New permanent pacemaker was required in 39 patients (18%); indication was complete heart block in 9. Rhythm at late follow-up (median: 4.1 years, maximum: 17.2 years) was 89% in the setting of congenital heart disease and 78% in acquired heart disease.

Atrial fibrillation is common with a variety of pathologies requiring redo cardiac surgery. Lesion set and energy source are dependent on primary procedure. Concomitant AF ablation during redo cardiac reoperations can be performed with reasonable safety and success.