Thorac Cardiovasc Surg 2008; 56(7): 386-390
DOI: 10.1055/s-2008-1038783
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Early and Late Results of Permanent Atrial Fibrillation Ablation Surgery in Aortic Valve and CABG Patients

S. Geidel1 , M. Lass1 , K. Krause2 , M. Betzold1 , H. Aslan1 , S. Boczor2 , K.-H. Kuck2 , J. Ostermeyer1
  • 1Abteilung für Herzchirurgie, Asklepios Klinik St. Georg, Hamburg, Germany
  • 2Abteilung für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany
Further Information

Publication History

received Dec. 20, 2007

Publication Date:
22 September 2008 (online)

Abstract

Objective: The study investigates the early and late results of permanent atrial fibrillation (AF) ablation surgery concomitant to coronary artery bypass grafting (CABG) and/or aortic valve (AV) surgery. Methods: Between February 2001 and April 2006, a selective group of 80 patients with permanent AF (median: 48 months [Perc25/75 24/110; range: 6 – 360 months]) underwent either bipolar (n = 60) or monopolar (n = 20) radiofrequency (RF) ablation procedures concomitant to CABG and/or AV surgery (CABG: n = 39; AV: n = 30; AV + CABG: n = 11). All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 ± 1 months) and late after surgery (30 ± 15 months). Data were analyzed exploratively. Results: Survival at 3 and 30 months was 98 % and 96 %, respectively. Stable SR could be documented in 73 % and 77 % of patients. Long-term AF before surgery and larger LA size were predictive for AF return after surgery (p = 0.004 and p = 0.032, respectively). Neither age, gender, the application modus of the RF energy nor the underlying cardiac disease influenced the postoperative cardiac rhythm significantly. NYHA class improved significantly after surgery (p < 0.0005), particularly when stable SR was achieved (p = 0.049). Conclusion: Preoperative permanent AF duration time and larger LA size are useful variables to predict the success rate of concomitant ablation surgery in CABG and/or AV patients. Further it could be demonstrated that established SR remained stable over time.

References

  • 1 Moe G K. On the multiple wavelet hypothesis of atrial fibrillation.  Arch Int Pharmacodyn Ther. 1962;  140 183-188
  • 2 Allessie M, Lammers W JEP, Bunke F I, Hollen J. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. Zipes D, Jalife J, eds. Cardiac electrophysiology and arrhythmias. New York; Cruno and Straiton 1985: 265-275
  • 3 Wijffels M CEF, Kirchhof C JHJ, Doland R. et al . Atrial fibrillation begets atrial fibrillation.  Circulation. 1995;  92 1954-1968
  • 4 Haissaguerre M, Jais P, Shah D C, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins.  N Engl J Med. 1998;  339 659-666
  • 5 Cox J L, Schuessler R B, Lappas D G, Boineau J P. An 8 œ years clinical experience with surgery for atrial fibrillation.  Ann Thorac Surg. 1996;  224 267-275
  • 6 Melo J, Andragao P, Neves J, Ferreira M, Timoteo A, Santiago T, Ribeiras R, Canada M. Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intraoperative device.  Eur J Cardiothorac Surg. 2000;  18 182-186
  • 7 Benussi S, Pappone C, Nascimbene S, Oreto G, Caldarola A, Stefano P L, Casati V, Alfieri O. A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach.  Eur J Cardiothorac Surg. 2000;  17 524-529
  • 8 Li D, Fareh S, Leung T K, Nattel S. Promotion of atrial fibrillation by heart failure in dogs. Atrial remodeling of a different sort.  Circulation. 1999;  100 87-95
  • 9 Goette A, Staack T, Röcken C, Arndt M, Geller J C, Huth C, Ansorge S, Klein H U, Lendeckel U. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation.  J Am Coll Cardiol. 2000;  35 1669-1677
  • 10 Kawara T, Derksen R, de Groot J R, Coronel R, Tasseron S, Linnenbank A C, Hauer R NW, Kirkels H, Janse M J, de Bakker J MT. Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis.  Circulation. 2001;  104 3069-3075
  • 11 Jahangiri M, Weir G, Mandal K, Savelieva I, Camm J. Current strategies in the management of atrial fibrillation.  Ann Thorac Surg. 2006;  82 357-364
  • 12 Bakir I, Casselmann F P, Brugada P, Geelen P, Wellens F, Degrieck I, Van Praet F, Vermeulen Y, De Geest R, Vanermen H. Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy.  Ann Thorac Surg. 2007;  83 331-340
  • 13 Roy D, Talajic M, Dorian P, Connolly S, Eisenberg M J, Green M, Kus T, Lambert J, Dubuc M, Gagne P, Nattel S, Thibault B. Amiodarone to prevent recurrence of atrial fibrillation.  N Engl J Med. 2000;  342 913-920
  • 14 Khargi K, Laczkovics A, Haardt H. et al .Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation in CABG and AVR patients are as effective as in mitral valve patients. Read at the 3rd EACTS/ESTS Joint Meeting, Leipzig, Germany, 15th September 2004 2004
  • 15 Geidel S, Ostermeyer J, Laß M, Geisler M, Kotetishvili N, Aslan H, Boczor S, Kuck K H. Permanent atrial fibrillation ablation surgery in CABG and aortic valve patients is at least as effective as in mitral valve disease.  Thorac Cardiovasc Surg. 2006;  54 91-95
  • 16 Gillinov A M, Pettersson G, Rice T W. Esophageal injury during radiofrequency ablation for atrial fibrillation.  J Thorac Cardiovasc Surg. 2001;  122 1239-1240
  • 17 Melo J, Berglin E, Sie H, Benussi S, Knaut M, Williams M, Hornero F, Marinelli G, Fulquet-Carreras E, Ridley P. Surgery for atrial fibrillation in mitral patients with and without additional procedures. Results at 5 years from an international registry. [Presented at the 86th AATS Annual Meeting, Philadelphia, PA, USA, 29.04. – 03. 05. 2006]

Dr. Stephan Geidel

Asklepios Klinik St. Georg
Abteilung für Herzchirurgie

Lohmuehlenstraße 5

20099 Hamburg

Germany

Email: s.geidel@asklepios.com

Email: Stgeidel@aol.com