Abstract 8609: Long-Term Outcomes of Surgical Treatment for Atrial Fibrillation in a Complex Population

Abstract

Objective: Surgical procedures are increasingly used to treat patients with long-standing persistent atrial fibrillation (AF). We sought to evaluate the safety and efficacy of various surgical approaches to AF at a high-volume tertiary surgical referral center. Methods: In this retrospective, single center study, we analyze our experience with the surgical treatment of AF. We evaluated 272 consecutive patients operated on, over a 9 year period. The surgical procedure for AF performed on each patient varied and was left up to the discretion of the surgeon with 29.8%(n=80) of patients receiving a complete right and left-sided Maze procedure including pulmonary vein isolation, 20.5%(n=55) of patients receiving a left-sided Maze procedure including pulmonary vein isolation, 4.9%(n=13) of patients receiving a right-sided Maze procedure including pulmonary vein isolation and 44.8%(n=120) of patients receiving pulmonary vein isolation alone. The vast majority of patients underwent at least one concomitant surgical procedure (93.7% AF surgery + concomitant surgical procedure, 6.3% stand-alone Maze). Patients were followed for a mean period of 42.3 months (+/-27 months). Cardiac rhythm was analyzed at discharge, 1-year follow-up visit and then re-analyzed on an annual basis. Results: In total 265 patients were analyzed, 4 patients were lost to follow-up and 3 expired prior to one year follow-up. Survival rates at 1-year were 96.5%. 50.2% of our patients were discharged in sinus rhythm. Additionally, 12.7% of patients received a new permanent pacemaker prior to their initial hospital discharge. At the 1-year follow-up visit 77% of patients were found to be in sinus rhythm or atrial paced rhythm and 23 % of patients were in AF/flutter. Our most recent analysis revealed 71.8 % of patients remain in sinus rhythm or atrial paced rhythm at up to 9 years post-surgical intervention. Conclusions: Surgical procedures for AF resulted in 1-year maintenance of sinus rhythm rates of 77%. These success rates appear largely maintained over a follow-up period of up to 9 years. Our patients were taken from a complex surgical population at a busy academic surgical center. We believe these numbers reflect real-world success rates in this patient population.