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Atrial Fibrillation Patients Have Low Embolism Rates After Minimally Invasive Surgical Ablation Regardless Of Stroke History
Buqing Ni, Jiaxi Gu, Junjie Du, Weidong Gu, Xiaohu Lu, Yongfeng Shao.
The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
OBJECTIVE: Current catheter ablation techniques for atrial fibrillation (AF) may obviate patients with prior stroke history because the risk of thromboembolism associated with interventional procedures in these patients is significantly high while any aggressive perioperative anticoagulation strategies may increase their bleeding complications. Minimally invasive surgical ablation with left atrial appendage (LAA) excision provides a safe alternative for this specific patient population. However its effect on thromboembolism prevention in high risk AF patients is still unknown. The purpose of this study was to compare the middle term outcomes of video-assisted surgical ablation and LAA excision between high risk AF patients with prior stroke and AF patients without stroke history.
METHODS: Report of 95 consecutive patients with lone AF underwent video-assisted epicardial surgical ablation and LAA excision because of the contraindication or failure of oral anticoagulation between May 2011 and May 2016. All patients were from an ongoing prospective Atrial Fibrillation Surgery Registry Study, of which 72 had stroke history and 23 did not. The 24 hour cardiac rhythm recording, ischemic stroke and systemic embolic events were regularly assessed after discharge from hospital.
RESULTS: The median follow-up period was 20 months (from 6 months to 66 months). Of 64 patients who had paroxysmal AF, 49 (76.6%) turned and remained in normal sinus rhythm after surgery. Among 31 persistent AF patients, 16 (51.6%) were in normal sinus rhythm postoperatively. No patient required a vitamin K antagonist for anticoagulation after surgery. During the follow-up period, no patient had stroke and only one patient (1.4%) who had prior stroke with CHADS2 score of 2 experienced mesenteric arterial embolism two months after surgery.
CONCLUSIONS: In our study populations, AF patients with prior stroke who underwent video-assisted epicardial surgical ablation and LAA excision have low risk of stroke and systemic embolic events after surgery although having higher baseline CHADS2 scores compared with low risk AF patients. All patients are free of anticoagulation therapy regardless their later AF recurrence rates after surgery.
| Characteristics | Total (n=95) | stroke history (n=72) | No stroke history (n=23) | p value |
| Age, y | 61.31 ± 0.96 | 61.85 ± 1.10 | 59.61 ± 1.96 | 0.3212 |
| Sex: male | 54/95 (56.8%) | 43/75 (57.3%) | 11/23 (47.8%) | 0.3426 |
| AF duration, y | 3(0.08~30) | 3(0.08~30) | 4(0.16~15) | 0.2882 |
| LA diameter, mm | 39.61 ± 0.57 | 40.08 ± 0.63 | 38.00 ± 1.24 | 0.1267 |
| Paroxysmal AF | 64/95 (67.4%) | 45/72 (62.5%) | 19/23 (82.6%) | 0.0811 |
| Persistent AF | 31/95 (32.6%) | 27/72 (37.5%) | 4/23 (17.4%) | 0.1756 |
| CHADS2 score <2 | 21/95 (22.1%) | 0/72 (0%) | 21/23 (91.3%) | <0.0001 |
| CHADS2 score=2 | 26/95(27.4%) | 25/72(34.7%) | 1/23 (4.3%) | 0.0032 |
| CHADS2 score≥3 | 48/95(50.5%) | 47/72(65.3%) | 1/23 (4.3%) | <0.0001 |
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