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Predictors Of Recurrence Of Paroxysmal Af After Concomitant Rfa Pv In Cabg
Vadim Popov, MD1, Amiran Revishvili
1, Egor Malyshenko
1, Maxim Anishchenko
1, Natalia Popova
1, Natalia Ardashova
1, Madina Kadyrova
1, Vladislav Aminov
2, Mihail Svetkin
2;
1A.V. Vishnevsky National Medical Research Centre of Surgery, Moscow, Russian Federation,
2Federal State Center of Cardio Vascular surgery (Chelyabinsk), Chelyabinsk, Russian Federation
BACKGROUND: Bipolar pulmonary veins radiofrequency ablation (RFA PV) is one of the most common surgical treatments of paroxysmal AF in patients undergoing CABG. Thus, it is relevant to identify a specific group of patients who is destined to have POAF after RFA PV and who will benefit from more advanced procedure.
METHODS:A retrospective assessment of the treatment results of 71 patients with coronary heart disease and paroxysmal atrial fibrillation (AF) was conducted. Exclusion criteria: emergency CABG surgery, heart valve disease, left ventricle aneurysm. Patients undergo standard on-pump CABG. PV RFA was performed with a bipolar clamp without aortic cross-clamping using parallel perfusion. Patients were divided into 2 groups - AF recurrence (group I, n=23) and absence of AF (group II, n=48). Baseline characteristics analysis showed that patients in group I were older than in group II (p=0.005). Also, patients in I group commonly had a BMI> 30 kg / m2 - 12 (52.2%) and 9 (18.8%), p = 0.006 and impaired glucose tolerance - 9 (39.1%) and 7 (14, 6%), p=0.034. AF/AFl history analysis showed that more patients had AF paroxysm at the time of the admission in group I - 9 (39.1%) and 6 in the II group (12.5%), p=0.02. There were no differences in coronary arteries lesions.
RESULTS:There were no significant differences in intraoperative (time of surgery, cross-clamping time, CPB-time) and postoperative (ventilation time, ICU-stay) parameters. According to the results of one-way regression analysis, the most significant predictors of AF recurrence and ablation failure were age over 60 years (RR-1.49; 95% CI 1.12-1.99), impaired glucose tolerance (RR-2.68; 95% CI1, 14-6.3), BMI>30 kg/m (RR-2.78; 95% CI 1.37-5.64), LA enlargement (RR- 1.21; 95% CI 1.02-1.43 ), AF paroxysm at the time of admission (RR-3.13; 95% CI 1.27-7.74). The multivariate analysis confirmed the significance of the “age over 60 years” parameter (p=0.046).
CONCLUSIONS:Certain factors consideration in every case solves the problem of predicting AF recurrence after CABG and helps to choose the optimal surgical treatment of AF.
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