Abstract
BackgroundConcomitant Surgical AF ablation is an established procedure, recommended in guidelines. However many surgeons are reluctant to perform AF ablation in patients with significantly enlarged left atrium. We therefore analyzed outcomes of patients with left-atrial diameter >55 mm undergoing concomitant AF ablation.MethodsBetween 05/2003 and 12/2012 124 patients with significantly enlarged left-atrium >55 mm underwent concomitant surgical AF ablation. Rhythm monitoring was accomplished by implantable loop recorder (ILR) interrogation (n = 54), or 24-h Holter-ECG (n = 70). Successful ablation was defined as AF Burden <0.5 % in ILR interrogation or absence of AF episode >30 s in 24-h Holter-ECG. Primary endpoint of the study was freedom from AF at 12 months follow-up.ResultsMean patient’s age was 65.7+/−9.6 years, 69.4 % were male. No major ablation or ILR related complications occurred. Mean LA diameter was 60.7+/−4.4 mm. Survival rate at one-year follow up was 94.4 %. 11 (8.8 %) patients received additional catheter-based ablation, while 23 (18.5 %) had an electrical cardioversion during follow-up period. Overall freedom from AF rate after one-year follow-up was 64.4 % and 59.4 % off antiarrhythmic drugs respectively. Logistic regression analysis identified preoperative paroxysmal AF, duration of AF and LA diameter > 70 mm as predictors for rhythm outcome at 12 months follow-up.ConclusionIn this patient cohort with significantly enlarged LA diameter, concomitant surgical AF ablation provided freedom from AF of 64.4 % after one-year follow-up. However in this patient population, an accurate postoperative care with interventions like medical or- electrical cardioversion and additional catheter based ablation is necessary to achieve satisfactory results.
Highlights
Concomitant Surgical Atrial fibrillation (AF) ablation is an established procedure, recommended in guidelines
The 2012 Guidelines for the management of AF issued by the European Society of Cardiology (ESC), European Association of Cardiothoracic Surgery (EACTS), and European Heart
Rhythm Association (EHRA) recommend concomitant surgical AF ablation for symptomatic patients, as well as asymptomatic patients with low risk for an ablation procedure [3]. Cox first reported his technique of surgical AF ablation using the cut-and-sew principle in 1987
Summary
Concomitant Surgical AF ablation is an established procedure, recommended in guidelines. We analyzed outcomes of patients with left-atrial diameter >55 mm undergoing concomitant AF ablation. Rhythm Association (EHRA) recommend concomitant surgical AF ablation for symptomatic patients, as well as asymptomatic patients with low risk for an ablation procedure [3]. Cox first reported his technique of surgical AF ablation using the cut-and-sew principle in 1987. This technique was modified and resulted in the so-called Cox maze III procedure, which, because of its excellent results, with success rates > 90 %, remained the gold-standard for surgical AF ablation for many years. The cut-and-sew principle was replaced by the application of various energy sources to create transmural atrial lesions, and the use of the procedure became
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