Long-term Results of Concomitant Surgical Ablation for Atrial Fibrillation
Simon Pecha, Susanne Ghandili, Stephan Willems, Hermann Reichenspurner, Florian Mathias Wagner.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: Concomitant surgical AF ablation is an established procedure, recommended in guidelines for patients with atrial fibrillation (AF) undergoing cardiac surgery. According to guidelines ablation success should be reported by 24h Holter ECG results. However information on long-term success, especially obtained by 24h Holter-ECG, is rare. We therefore analyzed rhythm course and long-term outcomes of our patients undergoing concomitant surgical AF ablation.
METHODS: Between 01/2003 and 04/2011, 486 patients underwent concomitant surgical AF ablation in our institution. Patients with 24h-Holter ECG rhythm status available between 5- and 11 years postoperative, were included in this retrospective data analysis (n=163)
Ablation lesions were either limited to a pulmonary vein isolation (n= 25, 15.3%), a more complex left atrial lesion set 97 (59.5%), or biatrial lesions (n= 41, 25.2%).
All follow-up rhythm evaluations were based on 24 h-Holter ECG, successful ablation defined by absence of AF episode longer than 30 sec. Primary endpoint of the study was freedom from AF during long term follow-up. Uni-and multivariate logistic regression analysis was used to identify predictors for rhythm outcome.
RESULTS: Mean patients age was 67.1 years, 56.2% were male. Mean follow-up time was 5.5 years (5-11 years). Surgical AF ablation provided freedom from AF rate of 57.2% during long-term follow-up, with significantly better results in patients with paroxysmal-compared to those with persistent AF (67.9% vs. 52.1% p=0.322). A stable rhythm course was observed during follow-up, without statistically significant differences between 12 months- and latest follow-up (mean 5.5 yrs; 63.3% vs. 57.2%; p=0.29).
Irrespective of ablation success, 53% of patients which were in sinus rhythm at latest follow-up, were still on oral anticoagulation drugs. Uni- and multivariate logistic regression analysis identified preoperative paroxysmal AF and left-atrial diameter as predictors for long-term ablation success.
CONCLUSIONS: Surgical AF ablation provided freedom from AF rate of 57.2 % during long-term follow-up. Statistically significant predictors for ablation success at latest follow-up were preoperative paroxysmal AF and a preoperative smaller left atrial diameter.
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