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Rhythm outcome predictors after concomitant surgical ablation for atrial fibrillation: a 9-year, single-center

Simon Pecha1, Timm Schäfer1, Irina Subbotina1

  • 1Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.

The Journal of Thoracic and Cardiovascular Surgery
|October 22, 2013
PubMed

Insights

Surgical ablation for atrial fibrillation (AF) is safe. Predictors for successful rhythm outcome include immediate postoperative sinus rhythm, smaller left atrial diameter, shorter AF duration, and biatrial ablation for persistent AF.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Concomitant surgical ablation is guideline-recommended for patients with atrial fibrillation (AF) undergoing cardiac surgery.
  • Identifying predictors of rhythm outcome is crucial for optimizing patient selection and procedural success.

Purpose of the Study:

  • To identify predictors of sinus rhythm (SR) outcome 1 year after concomitant surgical AF ablation.
  • To analyze the safety and feasibility of surgical AF ablation in a single center.

Main Methods:

  • A single-center analysis of 503 patients with persistent or paroxysmal AF undergoing surgical ablation between January 2003 and January 2012.
  • Ablation lesion sets included pulmonary vein isolation, left atrial lesions, or biatrial lesions.
  • Rhythm evaluations were performed using Holter ECGs and event recorders at 3, 6, and 12 months postoperatively.

Main Results:

  • Overall, 59.9% of patients achieved SR at 1-year follow-up.
  • Paroxysmal AF patients had significantly better SR outcomes than persistent AF patients (67.3% vs 54.8%, P=.0053).
  • Significant predictors for SR included immediate postoperative SR (P<.001), left atrial diameter (P=.0019), AF duration (P=.018), and preoperative paroxysmal AF.

Conclusions:

  • Immediate postoperative SR, smaller left atrial diameter, shorter AF duration, and preoperative paroxysmal AF are key predictors of successful rhythm control after 1 year.
  • Biatrial ablation demonstrated significantly higher rates of conversion to SR compared to solitary left atrial ablation in persistent AF patients (64.9% vs 51.4%, P=.044).
  • Concomitant surgical AF ablation is a safe and feasible procedure with favorable rhythm outcomes in selected patients.
Abstract

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