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DOI: 10.1055/s-2008-1038027
Determinants of atrial fibrillation following concomitant left atrial ablation
Treatment of atrial fibrillation (AF) by left atrial ablation has become an increasingly performed concomitant procedure in cardiac surgery. As recurrent AF is a risk factor for morbidity and mortality we investigated potential determinants of rhythm outcome.
Between January 2003 and December 2005, 162 consecutive patients (52.5% male, age 69±8.7 years) with permanent AF underwent concomitant left atrial (LA) ablation. Follow up (FU) was after 3, 6, 12 months and yearly thereafter. Predictive values of variables for postoperative AF were examined.
Perioperatively and during FU, 8 and 13 patients died (not ablation related). Two patients were lost to FU. At last FU (19±11.3 months), 86 patients (62%) were in stable SR –73 (52%) without antiarrhythmic drugs – and 43 (31%) were in AF. Proportional hazard regression analysis determined that predictors for AF recurrence were preoperative AF duration (hazard ratio [HR] 1.005 per 1-month increment in AF duration, 95% confidence interval [CI] 1.003–1.007, p<0.001) and LA size (HR 1.056 per 1-mm increment in diameter, 95% CI 1.020–1.093, p=0.002). Overall, SR conversion rate was 71% when preoperative AF duration was ≤3 years, but 43% in longer lasting AF with LA dilatation (>50mm). Age, gender, primary heart disease, history of thrombembolism or cardioversion, presence of concomitant diseases, EuroSCORE, left ventricular size and function, aortic cross clamp time, ablation technology, and treatment with antiarrhythmic drugs did not predict rhythm outcome.
AF duration and LA diameter are primary predictors of AF recurrence after concomitant LA ablation.