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Initial Experience of Non-Atriotomy Surgical Ablation During Coronary Artery Bypass Grafting With Preexisting Atrial
Armin Kiankhooy1, Gregory Rushing2, Marc Pelletier3
1Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Insights
A novel non-atriotomy surgical ablation (NASA) technique is safe for patients undergoing coronary artery bypass grafting (CABG). This procedure effectively restores normal sinus rhythm in most patients with atrial fibrillation within one year.
Area of Science:
- Cardiovascular Surgery
- Electrophysiology
- Medical Devices
Background:
- Surgical ablation for atrial fibrillation during isolated coronary artery bypass grafting (CABG) has poor guideline concordance.
- Barriers include the need for additional atriotomy and safety concerns.
- A novel non-atriotomy surgical ablation (NASA) left atrial box lesion technique was developed.
Purpose of the Study:
- To evaluate the initial safety of the NASA technique.
- To assess rhythm outcomes associated with NASA in patients undergoing isolated CABG.
- To determine the feasibility of combining ablation with CABG without additional atriotomy.
Main Methods:
- A multicenter retrospective review of patients undergoing concomitant NASA during isolated CABG for pre-existing atrial fibrillation.
- Primary outcome: NASA-related intraoperative complications.
- Rhythm outcomes assessed by Heart Rhythm Society criteria for freedom from atrial fibrillation (FFAF) at 12 months via continuous monitoring off antiarrhythmic medications.
Main Results:
- Ninety-seven patients were analyzed (median age 73 years, CHA2DS2-VASC score 4).
- No intraoperative complications attributed to NASA were observed (0%).
- Of 35 patients with 12-month monitoring, 94% achieved FFAF; 91% remained in normal sinus rhythm off antiarrhythmic medications.
Conclusions:
- Concomitant NASA is safe in patients undergoing isolated CABG.
- The procedure is associated with favorable restoration of normal sinus rhythm at 1 year.
- NASA offers a viable option for AF treatment in CABG patients.
Background:
Guideline concordance with surgical ablation in patients undergoing isolated coronary artery bypass grafting (CABG) is poor. Additional atriotomy and safety concerns are barriers to ablation. We sought to evaluate the initial safety and associated rhythm outcomes of a novel non-atriotomy surgical ablation (NASA) left atrial box lesion in patients undergoing isolated CABG.
Methods:
A multicenter retrospective review included all concomitant NASA in patients with preexisting atrial fibrillation undergoing isolated CABG. The primary outcome was NASA-related intraoperative complications. Associated rhythm outcomes were per the Heart Rhythm Society definition of freedom from atrial fibrillation, atrial flutter, and atrial tachycardia (FFAF) <30 seconds at 12 months off class I or III antiarrhythmic medications by >24-hour continuous monitoring. Data are reported as median (interquartile range).
Results:
Ninety-seven patients were analyzed. The median age was 73 (68-76) years; CHA2DS2-Vasc score, 4.0 (3-5); left ventricular ejection fraction, 55% (45%-60%); and left atrial diameter, 4.0 (3.6-4.7) cm. Most patients (86% [83/97]) had paroxysmal atrial fibrillation. The primary safety outcome of intraoperative complications attributed to NASA was not observed (0% [0/97]). Thirty-five patients (35/97 [36%]) had at least 12 months (median, 12 months; interquartile range, 12-24 months) of continuous ambulatory monitoring, and FFAF was 94% (33/35); 91% (29/32) showed FFAF off antiarrhythmic medications.
Conclusions:
In patients with mostly paroxysmal atrial fibrillation undergoing isolated CABG surgery, concomitant NASA was safe and associated with favorable restoration of normal sinus rhythm at 1 year.
