Objectives: In patients with paroxysmal AF undergoing CABG or AVR, many surgeons are reluctant
to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Isolated
PVI is often preferred in those patients. We here analyzed rhythm course and outcome
of patients with PVI compared with those receiving an extended left atrial lesion
set.
Methods: Between 01/2003 and 06/2015, 620 patients, underwent concomitant surgical AF ablation
in our institution. 206 patients with paroxysmal AF were treated with surgical ablation
concomitant to AVR or CABG. 63 patients received a complete Cox Maze left atrial lesion
set, while 143 patients were treated with an isolated pulmonary vein isolation. There
were no statistically significant differences regarding baseline patient characteristics.
Primary endpoint of the study was freedom from AF at 12 months follow-up.
Results: No major ablation-related complications occurred in any of the groups. In PVI group,
3 patients (2.1%) experienced intraoperative stroke, while 1 (1.2%) of patients had
a stroke in extended LA ablation group. In patients receiving extended LA lesion set,
mean cross clamp time was 18 ± 6.3 minutes longer, compared with PVI group. In-hospital
mortality was 3.1% in PVI group, and 2.1% in extended LA group (p = 0.34). Freedom from AF at 12 months follow-up was 77% in extended LA ablation group
versus 73% in PVI group, showing no statistically significant difference (p = 0.25). A higher rate of symptomatic left atrial flutter was observed in PVI group,
compared with extended LA group (n = 3; 4.7% vs 0% p = 0.32).
Conclusion: Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is
safe and effective. There was no statistically significant difference between PVI
and extended LA lesion set regarding freedom from AF rate after 12 months. Patients
in extended LA group had a longer cross-clamp time, but fewer rate of postoperative
left-atrial flutter. Thus, PVI may be sufficient in this patient population.
