Mid-long term outcomes of surgical ablation for atrial fibrillation during concomitant cardiac surgery

Abstract

Objective To evaluate the clinical course of surgical ablation of atrial fibrillation during concomitant cardiac surgery and to identify the independent risk factors for recurrence of atrial fibrillation, atrial flutter or death. Methods Retrospective analysis was made in 1 003 surgical ablation cases from October 2004 to March 2014. They were divided into two groups according to composite endpoints including death, recurrence of atrial fibrillation or atrial flutter. Risk factors were identified using univariate analysis, Cox regression analysis and Kaplan-Meier survival analysis. Results 895 of 992(90.2%) survival cases at discharge were followed up. The rate of freedom from composite endpoints at 1, 2, 3 years was 88.9%, 81.8%, 72.6%, respectively, with a median follow-up time of(30.0±22.4) months. Independent risk factors of ablation failure were atrial fibrillation or atrial flutter at discharge(HR=3.20, 95%CI: 2.53-4.05), left atrium diameter≥50 mm(HR=1.36, 95%CI: 1.06-1.75), right atrium diameter≥55 mm(HR=1.60, 95%CI: 1.24-2.07), age≥60 years(HR=1.39, 95%CI: 1.09-1.77). Conclusion Surgical ablation has a high success rate. Atrial fibrillation or atrial flutter at discharge, left atrium diameter≥50 mm, right atrium diameter≥55 mm and age≥60 years are the major independent risk factors of ablation failure. Key words: Atrial fibrillation; Catheter ablation; Cardiac surgical procedures; Risk factors