Benefit of surgical ablation of permanent atrial fibrillation in advanced age patients

Objective: The purpose of this study was to assess the mid-term results of Cox mini-maze lesion set using bipolar irrigated radiofrequency for left atrial (LA) ablation in advanced age patients with permanent atrial fibrillation (AF) undergoing open heart surgery. Methods: Forty nine patients underwent a Cox-maze like LA ablation procedure using the Cardioblate device. Ten patients (Group A) were older than 75 years and 39 patients (Group B) were younger. The ablation procedure was performed concomitant to coronary (n=7), mitral valve (n=17), aortic valve surgery (n=3), and combined procedures (n=22). A combined procedure was performed in 4 patients (40%) in Group A and in 18 patients (46%) in Group B. A mitral valve procedure was performed in 5 patients (50%) in Group A and in 30 patients (77%) in Group B. Results: One patient (Group B) died in hospital (not related to the ablation procedure). In 3 patients (Group A=1, Group B=2) a permanent pacemaker was necessary but no other complications associated to the ablation procedure were seen. Late mortality was 20% (n=2) in Group A and 2.6% (n=1) in Group B. At six months follow-up 5 patients (62.5%) in Group A and 37 (86.5%) in Group B were in sinus rhythm and presented a substantial LA contraction. Conclusions: Surgical ablation for treatment of permanent AF during concomitant cardiac procedures is safe and effective with 86.5% success rate at six months follow-up in patients younger than 75 years. In our experience ablation of AF in advanced age patients doesn't improve survival. Conversion rate to sinus rhythm was modest in this patient population.