Outcomes Of The Pulmonary Vein Ablation For The Prevention Of Atrial Fibrillation After Cabg
Amiran Revishvili, Vadim Popov, Egor Malyshenko, Maksim Anishchenko, Giorgiy Edzhibiya.
A.V.Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation.
BACKGROUND:To evaluate results in prospective RCT PULVAB (Prophylactic Pulmonary Vein Ablation) after CABG
METHODS:PULVAB (NCT03857711) is a prospective randomized clinical trial that enrolled 175 patients with coronary artery disease without a history of AF. Patients were randomized into four groups: the I group included patients underwent CABG alone (n=47); the II group-CABG and amiodarone medical therapy (n=42); the III group - CABG with RFA PV (n=44); the IV group - CABG with RFA PV and amiodarone medical therapy (n=42). Bipolar RFA was performed with parallel CPB before the stage of CABG
RESULTS:No cases of in hospital mortality were documented. No cases of bleeding, perioperative stroke and MI were documented. Adding RFA didn’t impact on the surgery timing, surgery duration (p=0.18), X-clamp time (p=0.15) and CBP time (p=0.07) were comparable. POAF occurred in 40.4% (19/47), 30,9% (13/42), 15,9% (7/44), 7,1% (3/42) in I, II, III, IV groups, respectively.No significant difference was found comparing I and II groups (p=0.52), and II and III groups (p= 0.31), III and IV (p= 0.16). A significant decrease in rates of POAF were shown in III (p=0.03), IV (p=0.004) compared to I group, that can be related to a high preventive efficacy of both techniques: RFA PV only or in combination with amiodarone. The sinus rhythm had 95.8%, 95.3%, 97.7% and 97.6% in groups I, II, III and IV, respectively (p=0.28). No cases of long-term mortality were documented. Freedom from MACCE was 93.5%, 95.8%, 98% and 98% in groups, respectively. Freedom from AF/ AFL was 82.5%, 85.5%, 93.1% and 98,0% in I, II, III and IV groups, respectively, during 1-year-follow up
CONCLUSIONS:RFA PV only or in combination with amiodarone as a preventive method significantly reduces the occurrence of new onset AF after CABG and does not increase the rates of short- and long-term complications
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