Efficacy of Surgical Ablation of Atrial Fibrillation in Patients With Rheumatic Heart Disease

Abstract

Although atrial fibrillation (AF) ablation is efficient in many patient cohorts, its effect on rheumatic heart disease remains controversial. We describe a retrospective comparison of surgical ablation using the same technique in rheumatic versus nonrheumatic patients. Between 2004 and 2009, we performed AF ablation as a part of another cardiac surgery in 192 patients with bipolar radiofrequency ablator and a cryoprobe. Patients were retrospectively allocated to a rheumatic heart disease group (76 patients, 40%) and a nonrheumatic heart disease group (116 patients, 60%). All demographic characteristics were similar in both groups, as well as in a number of patients with permanent and persistent AF and long-standing AF. Permanent AF was present in 37 patients (49%) and 51 patients (44%) in the rheumatic and nonrheumatic groups, respectively. Heart function and functional class were also similar, whereas more rheumatic patients had a severely enlarged left atrium (200 to 300 cc [p = 0.02]). There were 2 perioperative deaths. Postoperative complications were similar in both groups, with 51 rheumatic patients (67%) and 81 nonrheumatic patients (70%) in sinus rhythm at discharge. Total, mean follow-up was 16 months, after which 63 patients (83%) and 96 patients (84%) were in sinus in the rheumatic group and nonrheumatic group, respectively, of whom 72% were without antiarrhythmic medications. Ablation failure risk factors included AF duration of 10 years or longer before ablation (p < 0.05), and preoperative permanent AF (p = 0.03). The efficacy of AF ablation proved similar in rheumatic and nonrheumatic patients, providing preoperative AF type and duration were similar. Larger left atria in rheumatic patients did not influence ablation results.