Outcome Predictors for Surgical AF Ablation Concomitant to Mitral Valve Surgery
Simon Pecha, Johannes Petersen, Yousuf Alassar, Stephan Willems, Hermann Reichenspurner.
University Heart Center Hamburg, Hamburg, Germany.
Objectives: Concomitant surgical ablation is an established procedure, recommended in guidelines for patients with atrial fibrillation (AF) undergoing cardiac surgery. AF is very common among patients with mitral valve disease. We therefore analyzed predictors of rhythm outcome in a large patient collective receiving mitral valve surgery and concomitant ablation.
Methods: Between 2003 and 2016, 419 patients with persistent (n= 266, 63.5%) or paroxysmal (n= 153, 36.5 %) AF underwent surgical AF ablation concomitant to mitral valve surgery. 209 (49.8%) patients received isolated MVR, while 210 (50.1%) patients received combined mitral valve procedures. The lesions were either limited to a pulmonary vein isolation (n= 39, 9.3%), a complete left atrial lesion set 256 (61.1%), or biatrial lesions (n= 124, 29.6%). Follow-up rhythm evaluations were based on either 24 h-Holter ECG or event recorder interrogation at 3, 6, and 12 months postoperatively.
Results: Mean patients age was 66.1+/-14.6 years, 238 (56.8%) were male. There were no major ablation-related complications. Survival rate after 1 year follow-up was 93%. After 1-year follow up, freedom from AF was 65.2%, showing significantly better results in patients with paroxysmal AF compared to those with persistent AF (75.6%vs.58.3%, p=0.0014). Logistic regression analysis confirmed smaller left atrial diameter (p=0.023), and paroxysmal AF (0.0011) as statistically significant predictors for freedom from AF. Neither energy source, nor additional surgical procedure significantly influenced rhythm results. Regarding only patients with persistent AF, those receiving a biatrial lesion set showed a trend towards higher rates of freedom from AF, but without statistically significant differences (biatrial 66.9% vs. left-atrial 55.3%, p=0.067)
Conclusion: Surgical AF ablation, concomitant to mitral valve surgery is a safe and effective procedure. Statistically significant predictors for freedom from AF after 12 months were preoperative paroxysmal AF and smaller left atrial diameter.
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