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Attrition of sinus rhythm in mid-term and long follow-up after surgical ablation of atrial fibrillation.
Leonid Sternik, Alexander Kogan, David Luria, Michael Glikson, Ateret Malachy, Shany Levin, Ehud Raanani.
Sheba Medical Center, Ramat-Gan, Israel.

OBJECTIVE: Atrial fibrillation (AF) surgical ablation is widely used procedure. It's positive early and mid post-operative effect seem to decline in the late follow-up. We describe late follow up of the surgical AF ablation and factors influencing the AF recurrence years after the ablation.
METHODS: Between February 2004 and December 2009 we performed AF ablation with the same technique using bipolar radiofrequency ablator and cryoprobe as a part of another cardiac surgery in 212 patients. Patients were 63±11 years of age. 79 (39%) patients had permanent and 86 (42%) persistent atrial fibrillation. 25 (14%) had left atrial volume >200 cc. 75% of patients underwent mitral valve surgery. 79% had left atrial ablation and 21% biatrial ablation.
RESULTS: Mean follow up was 39 months (range 26-70 moths). The follow up was performed by electro physiologists and surgeons. Sinus rhythm was found in 83%, 81%, 72%, and 72% of patients at 6 month, 1, 3, and 5 years after the ablation correspondently. The attrition of sinus rhythm was insignificant (p>0.005). 38%, 43%, 35%, and 41% of patients were free from antiarrhythmic medications at 6 month, 1, 3, and 5 years after the ablation correspondently. The only patient factor related to ablation failure in the late follow-up was pre-operative permanent AF (p=0.001). The duration of AF pre-ablation, left atrial size, age and other demographic parameters were not found to be related to AF recurrence.
CONCLUSIONS: The efficacy of AF ablation seems to decline not significantly in the late follow-up. Patients with permanent AF can be expected to have a high rate of AF recurrence in the late follow-up.


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