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DOI: 10.1055/s-2008-1037682
Long-term outcome of intraoperative ablation of permanent atrial fibrillation
Short- and medium term success of intraoperative radiofrequency ablation to treat permanent atrial fibrillation (AF) are well documented. Is conversion to sinus rhythm (SR) long-term stable during follow-up of over 3 years?
Methods: 126 patients who had undergone intraoperative saline irrigated cooled-tip radiofrequency ablation (SICTRA) of permanent AF (>1 year AF-duration) concomitant to open heart surgery more than 3 years ago were followed up using ECG and echocardiography. Stable SR was documented based on ECG and atrial contraction based on atrio-ventricular doppler-echo profile.
Results: Patients received mitral valve replacement in 18, mitral valve reconstruction in 24, aortic valve replacement in 14, CABG procedures in 48 (including 10 patients with additional mitral valve surgery) and complex procedures in 22 cases 52±14 (range 36–91) months ago. 69% of patients (84/122) were in stable SR whereas 28% (34/122) were in AF and 3% (4/122) were in atrial flutter. During the follow-up period 9 patients (7%) converted to AF after having documented SR and 2 patients (2%) converted to atrial flutter. Comparing patients after left to biatrial SICTRA no significant difference in rhythm success (74% versus 60%) was documented (p=0.59). Echocardiography revealed 67% of patients in SR to have biatrial contraction.
Conclusions: SICTRA effectively restores long-term stable SR in 69% of patients. 9% of patients reconverted back to atrial arrhythmia during follow-up. There is no difference in long-term rhythm efficacy when limiting the SICTRA to the left atrium alone.