Análisis del remodelado anatomoeléctrico auricular para la predicción del éxito de la ablación quirúrgica concomitante de la fibrilación auricular a largo plazo

Abstract

ObjectiveTo identify preoperative parameters of anatomo-electrical atrial remodelling in order to identify the subgroup of patients more favourable to long-term sinus rhythm (SR) re-establishment after concomitant ablation of persistent-permanent atrial fibrillation (AF). MethodsThe study included 50 consecutive patients undergoing concomitant surgical ablation of persistent-permanent AF with cryoablation and bipolar radiofrequency Maze IV pattern. The variables collected before the operation were; demographic variables, morbidity, AF evolution time, transthoracic echocardiographic study, and digital electrocardiogram register for f-wave signal organisation analysis (sample entropy [SampEn]). An assessment was also made of the individual and combined association of atrial remodelling parameters with SR restoration by area under ROC curve (AUC). ResultsFollow-up 22.32±3.19 months. Mean AF onset time 4.00±4.28 years. Mean left atrium diameter 49.90±8.18mm (range=32 – 81mm), and SR restoration of 62% at the end of follow-up. Parameters best linked to postoperative SR restoration were left atrium diameter (AUC=0.848) and SampEn (AUC=0.845). Cut-off points were 50mm and 0.0857, respectively, obtaining a model with a predictive accuracy when both parameters combined with an AUC=0.893. ConclusionsPreoperative anatomo-electrical remodelling analysis through indirect non-invasive variables could be useful to select patients more favourable to SR restoration after concomitant ablation of AF.