Surgical ablation for persistent atrial fibrillation in concomitant cardiac surgery: mid-long-term result†

OBJECTIVES: Surgical ablation is an option for patients with atrial fibrillation (AF) undergoing concomitant cardiac surgery. This study aims to evaluate the outcome of surgical ablation during concomitant cardiac surgery and to identify the independent predictors for a primary end-point consisting of AF or atrial flutter (AFL) recurrence, death, permanent pacemaker implantation and necessity for anti-arrhythmic drugs and the effects of reintervention for AF/AFL recurrence. METHODS: A retrospective analysis was performed for 1028 patients who underwent surgical ablation during concomitant cardiac surgery from October 2004 to April 2015. Nine hundred and twenty-seven of 1017 (91.2%) discharged patients were followed up. Sixty-three recurrent patients received reintervention. Predictors of ablation failure were identified using univariate analysis and the Cox regression model. RESULTS: The mean follow-up length was 29.0 ± 22.7 months. The New York Heart Association class, ejection fraction, left atrial and right atrial diameters and left ventricular end-diastolic diameter were improved at follow-up compared with the preoperative status. The rate of freedom from the primary end-point at 1, 2 and 3 years was 86.8, 79.4 and 68.3%. Independent predictors of reaching the primary end-point were AF/AFL at discharge, preoperative right atrial diameter, hypertension, diabetes and smoking. The rate of sinus rhythm without anti-arrhythmic drugs at 12, 24 and 36 months after reintervention was 78.3, 62.8 and 49.9%, respectively. CONCLUSIONS: Surgical ablation has a high success rate and may improve cardiac function postoperatively. AF/AFL at discharge, preoperative right atrial diameter, hypertension, diabetes and smoking are the major independent predictors for ablation failure. Reintervention in AF/AFL recurrent patients can achieve a favourable clinical outcome.