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DOI: 10.1055/s-0029-1246928
Permanent atrial fibrillation ablation concomitant to coronary surgery
Objective: To analyse the results of permanent atrial fibrillation (pAF) ablation procedures concomitant to coronary artery bypass grafting (CABG) as well as risk factors for postoperative pAF return.
Methods: Since February 2001 a total of 126 consecutive patients (age: 72±7 years) with pAF (duration: 0.5–33 years) underwent pAF-ablation concomitant to CABG creating two encircling isolation lesions around the left and the right pulmonary veins and a connecting lesion between both using radiofrequency ablation procedures. Patients were restudied 10 days, 3 months and 3 years after surgery.
Results: Survival at time of re-examination was 96.8%, 95.1% and 94.7%, respectively (4 cardiac and 2 non-cardiac deaths), stable sinus rhythm (SR) could be documented in 66.4%, 75.1% and 75.9% of patients. Long-term pAF before surgery and larger size of the left atrium (LA) were predictive for postoperative pAF return (p<0.01): 89.1% of patients with pAF-duration time of <5years and 86.2% of patients with LA-size ≤50mm had stable SR at late follow-up. Cardiac rhythm at 3 months postoperatively was predictive for long-term rhythm prognosis (p<0.01). Neither age nor other concomitant diseases (e.g. diabetes, arterial hypertension, renal insufficiency or pulmonary disease) influenced postoperative cardiac rhythm significantly.
Conclusion: Duration time of pAF and LA-size are the most reliable variables to predict the success-rate of ablation in CABG-patients. The probability to re-establish stable SR is excellent when pAF-duration time is short and LA-size small.