Concomitant surgical atrial fibrillation ablation in patients over 75 years. Worth the effort?
Simon Pecha, Teymour Ahmadzade, Stephan Willems, Hermann Reichenspurner, Florian Mathias Wagner.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: Concomitant surgical atrial fibrillation (AF) ablation is a safe and feasible procedure, recommended in guidelines. The incidence of AF is increasing with age, and nowadays in an aging population a growing number of elderly patients with AF presents for cardiac surgery. In those patients, many surgeons are reluctant to perform AF ablation and in literature there is little known about outcomes of this patient cohort. We therefore investigated safety and efficacy of concomitant surgical AF ablation in patients aged over 75 years.
METHODS: Between 01/2003 and 09/2012, 586 patients underwent concomitant surgical AF ablation. Of these patients, 154 were aged over 75 years and were included in this retrospective data analysis. 69 patients presented with paroxysmal AF, while 85 had persistent- or long-standing persistent AF. The lesions were either a pulmonary vein isolation (n= 35, 22.7%), a complete left atrial lesion set (n=85 55.2%), or biatrial lesions (n=34, 22.1%). Follow-up rhythm evaluations were based on either 24 h-Holter ECG (n=103) or event recorder (n=51) interrogation.
RESULTS: Mean patients age was 78.2+/-2.6 years, 59.0% were men. There were no major ablation-related complications. No intraoperative death occurred in any of the patients. 30-day and 1-year survival rate was 96.3% and 93.5% respectively. 3 patients experienced perioperative stroke. Permanent pacemaker implantation was necessary in 13 (8.4%) patients. At 3- and 6 months follow-up 52.0% and 59.5 % of patients were in SR respectively. SR rate at 1-year follow up was 63.3% and 58.8% off antiarrhythmic drugs. Patients with paroxysmal AF had statistically significant higher rate of SR compared to those with persistent AF (73.1% vs. 55.4% p=0.028). Demographic data and preexisting diseases did not have any impact on rhythm after 12 months. Neither type of operation nor type of energy source did have an influence on SR rate.
CONCLUSIONS: Surgical AF ablation in patients older than 75 years was safe and feasible without ablation- related complications. Overall sinus SR rate after 1-year follow-up was 63.3%, with statistically higher rate of SR restoration in patients with paroxysmal AF compared to those with persistent or long-standing persistent AF
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