Permanent Atrial Fibrillation Ablation Surgery in CABG and Aortic Valve Patients is at Least as Effective as in Mitral Valve Disease

Abstract

Background: Data on combined permanent atrial fibrillation (pAF) surgery and coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) are scarce, and the mid- and long-term effects on survival and cardiac rhythm are unknown. Material and Methods: In a prospective analysis 125 patients (Group I: CABG and/or AVR, n = 50; Group II: mitral valve [MV] surgery, n = 75) with pAF (≥ 6 months) underwent either concomitant monopolar (Group I: n = 20; Group II: n = 75) or bipolar (Group I: n = 30) radiofrequency (RF) ablation procedures. Group I patients had a significantly smaller left atrial (LA) size than Group II patients (LA-diameter: 47.7 ± 4.6 vs. 58.2 ± 6.1 mm; p < 0.01). Regular follow-up was performed from 3 to 36 months after surgery to assess survival, NYHA-class, and conversion rate to stable sinus rhythm (SR). Results: Early mortality (< 30 days) of Group I patients was 0 % (Group II: 2.7 %), cumulative survival at long-term follow-up was 0.95 vs. 0.82 (p = 0.31) and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At follow-up 80 % of Group I patients had SR (Group II: 70 %). In Group I patients the bipolar approach was associated with significantly shorter ablation procedure times compared to the monopolar procedure (12.1 ± 3.4 vs. 18.9 ± 1.6 min; p < 0.05). Conclusions: Concomitant pAF ablation surgery in CABG and/or AVR is safe and at least as effective as in MV surgery, presumably because severe LA enlargement is exceptionally rare in this group.

Key words

Atrial fibrillation - atrial fibrillation surgery - radiofrequency ablation - arrhythmia surgery - bipolar radiofrequency ablation

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