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Objective: The study investigates long-term efficacy of surgical left atrial ablation for atrial fibrillation (AF) synchronous with minimally invasive mitral valve surgery. The resulting data was collected for quality assurance and forms the basis for comparisons with other institutions.
Methods: The study is based on a single-centre clinical trial with partly retrospective and partly prospective design. 54 patients, who underwent minimal invasive mitral valve surgery with additional radiofrequency left atrial ablation at our institution between October 2006 and April 2011 where examined in a long-term follow-up of 45 ± 18 months.
Cardiac rhythm, echocardiographic parameters and patient characteristics were assessed by single ECG, 24 hours Holter monitoring, prolonged continuous Holter monitoring, telephone interviews with patients, consultation of attending cardiologists or physicians and by retrieving data from the clinical information system. For statistical analysis of data, chi-square test, fisher’s exact test, student t-test, Kaplan Meier Analysis and log rank test were used. Assessment of quality of life was performed by means of SF-36 health survey.
Results:

	Freedom of AF in total study population (n = 54)	Freedom of AF in persistent AF patients (n = 29)	Freedom of AF in long-standing persistent AF patients (n = 21)
At discharge	59.3%	69.0%	47.6%
After 3 months	88.9%	89.7%	90.5%
After 6 months	77.8%	79.3%	81.0%
After 1 year	68.5%	69.0%	71.4%
After 2 years	53.6%	55.0%	57.1%
After 3 years	39.2%	50.4%	32.5%
After 4 years	36.1%	44.8%	32.5%
After 5 years	28.4%	31.3%	32.5%

Binary logistic regression showed that age at time of surgery, episode of AF during hospitalisation and preoperative arterial hypertension were predictors for the recurrence of AF.
Conclusion: Minimally invasive mitral valve surgery synchronous with surgical left atrial ablation results in high rates of sinus rhythm at discharge and in the long-term. Freedom from AF within the first year, however, is not predictive for long-term results. Evaluation and comparison of differing techniques may lead to improvement of long-term outcome in surgical patients with AF.