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DOI: 10.1055/s-0032-1332465
Predictors of pacemaker implantation after concomitant surgical ablation for atrial fibrillation (AF)
Objectives: Concomitant surgical AF ablation is a safe and feasible procedure, recommended in guidelines. Pacemaker dependency is a known complication after AF ablation surgery. We sought to determine independent predictors for pacemaker implantation after surgical AF ablation.
Methods: Between 01/2003 and 10/2011 503 Patients underwent concomitant surgical ablation due to persistent (n = 290; 57%) or paroxysmal (n = 213; 43%) AF. Various energy sources and lesion sets were used. A retrospective data analysis was accomplished. Uni- and multivariate analysis was used to identify independent predictors for pacemaker dependency after surgical AF ablation.
Results: Mean patient's age was 72.7 ± 9.5 years, 66.1% were male. 36 (7.2%) patients received pacemaker implantation within 30 days postoperatively. Indications for pacemaker implantation were Atrioventricular block in 22 cases, Sick Sinus syndrome in 7 cases and bradycardia/tachycardia syndrome in 7 patients. Demographic data and pre-existing diseases did not have any impact on pacemaker implantation. Neither type of operation nor type of energy source (cryo: n = 131; radiofrequency: n = 372, unipolar: n = 288; bipolar: n = 84) did have a significant impact on pacemaker implantation rate. 421 (83.7%) ablation procedures were done on the left-atrium, 82 (16.3%) bi-atrially. Biatrial lesions were the only factor to be correlated with post ablational permanent pacemaker dependency (6.4 vs. 13.1%; p = 0.038).
Conclusion: Concomitant surgical AF ablation showed permanent pacemaker implantation rate of 7.2% after 30 day follow up. In this series only biatrial ablation was found to be a statistically significant predictor for pacemaker dependency in uni- as well as multivariate analysis.