Does Prophylactic Pulmonary Vein Isolation Decrease The Incidence Of Atrial Fibrillation After СABG?
Amiran Sh. Revishvili, Vadim A. Popov, Egor S. Malyshenko, Amiran Sh. Revishvili, Maksim M. Anishchenko.
A.V. Vishnevsky Institute of Surgery, Moscow, Russian Federation.
Background.To evaluate early results in prospective RCT PULVAB (Prophylactic Pulmonary Vein Ablation) for CABG.Methods. The RCT including 96 patients with CAD was conducted. There were three groups:Group 1 (n=34) was the controlled group of the conventional CABG without ablation.In group 2 (n=29) conventional CABG was combined with prophylactic pulmonary RF bipolar ablation. In group 3 conventional CABG and prophylactic a pulmonary vein ablation was added with the administration of amiodarone in the postoperative period.Results. Concomitant ablation did not lead to the increase of the operation main stages length. The time of operation was 251 ± 37.7 min in I group, 250.4 ± 42.5 min in II group and 244.2 ± 29 min in III group. p = 0.114) and did not differ in the CPB time (88.6 ± 19.2; 92 ± 18.4 and 84.8 ± 17.3 min p = 0.08).In-hospital mortality was 0 among the studied groups. Wound complications, bleeding, perioperative myocardial infarction and stroke weren't also noted.Postoperative Atrial Fibrillation (AF) was registered in 11 (32.4%) patients from the 1st group, in 6 (20.7%) from the 2nd group and in 2 (6.1%) from the 3rd group. There was no significant difference between groups 1 and 2 (p = 0.298) and also between groups II and III (p=0.086). Statistically significant difference was registered between patients from groups I and III (p = 0.0065), which indicates the effectiveness of combined methods for preventing AF. AF in 91% of patients occurred at 2-4 days of the postoperative period. Sinus rhythm at discharge was recorded in 97.1% (group I); 96.7% (groupII) and 97% (group III), respectively (p = 0.293). Conclusion. There was a tendency to a decrease in the frequency of AF in patients undergoing preventive bipolar RFA of the pulmonary veins. The combination of prophylactic bipolar RFA and amiodarone usage revealed significantly positive results in the postoperative AF prevention.
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