Radiofrequency pulmonary vein isolation for the prevention of new-onset atrial fibrillation after coronary artery bypass grafting

Abstract

Aim. To evaluate the in-hospital results of the epicardial bipolar radiofrequency ablation of the pulmonary vein in the prevention of new-onset postoperative atrial fibrillation (POAF) in coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) surgery in a pilot randomised multi-centre controlled Pulmonary Vein Ablation (PULVAB).Methods. The pilot study was conducted for the organisation of a multi-centre randomised PULVAB trial. We enrolled 63 CAD patients without a history of AF. The inclusion criterion was CAD demanding CABG; the exclusion criteria were as follows: AF history, antiarrhythmic therapy in anamnesis, significant heart valve disease, severe renal failure and decompensating diabetes mellitus. The patients were randomised into 2 groups. Group I comprised 34 patients who underwent CABG alone, and Group II had 29 patients who underwent CABG combined with radiofrequency ablation (RFA) as the initial tool for POAF prevention. All the procedures were performed by a single surgical team using standardised anaesthetic and perfusion support.Results. There was no in-hospital mortality in either group. There were differences in the duration of the intervention, cardiopulmonary bypass time and the aorta clamping time between groups (p > 0.05). A higher incidence of POAF was observed (11 %–32.4 %) in the isolated CABG group than in the CABG combined with PULVAB group (6 %–20.7 %), although the difference was not significant (p = 0.29). In most cases (91 %), AF occurred on the second to third postoperative day, irrespective of the observation group.Conclusion. The combination of CABG and RFA does not complicate the operation and does not increase the duration of the surgery or time of cardiopulmonary bypass. There were no significant differences in the postoperative course or the incidence and structure of complications between the groups. This may indicate the safety of our method. The positive tendency of POAF-cases decrease after preventive epicardial RFA observed in the present study allows us to continue the PULVAB study to gain more statistically significant results.Clin.Trials.gov Identifier: NCT03857711 Received 20 February 2020. Revised 29 June 2020. Accepted 2 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.Sh. Revishvili, V.A. PopovData collection and analysis: M.M. Anishchenko, E.S. Malyshenko, N.V. PopovaStatistical analysis: M.M. AnishchenkoDrafting the article: G.P. Plotnikov, M.M. AnishchenkoCritical revision of the article: A.Sh. Revishvili, V.A. PopovFinal approval of the version to be published: A.Sh. Revishvili, V.A. Popov, E.S. Malyshenko, G.P. Plotnikov, M.M. Anishchenko, N.V. Popova