Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity

Susanne Rohrbach; Elisabeth Dominik; Nikolas Mirow; Sebastian Vogt; Andreas Böning; Bernd Niemann

doi:10.1055/s-0041-1731772

September 14, 2021The Thoracic and Cardiovascular Surgeon

Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity

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Why the study?

Although concomitant surgical ablation can achieve freedom from AF in permanent AF, surgeons may hesitate to perform it to avoid perioperative risk escalation.

Does concomitant epicardial bipolar radio frequency ablation improve freedom from atrial fibrillation in patients with permanent or paroxysmal AF?

Structured PICO

Does concomitant epicardial bipolar radio frequency ablation improve freedom from atrial fibrillation in patients with permanent or paroxysmal AF?

P

Population

65 ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) undergoing concomitant cardiac surgery

I

Intervention

Concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR)

O

Outcome

Freedom from atrial fibrillation (FREEAF) at 24 monthssurrogate

Concomitant surgical ablation achieves high rates of long-term sinus rhythm even in patients with permanent AF, with obesity and cardiac dilation predicting recurrence.

Implication

Concomitant ablation achieves durable sinus rhythm even in permanent AF; Level 5 data leaves optimal patient selection by age, LV size, and obesity open.

Abstract

Objectives Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study. Methods Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling. Results Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: −6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (−7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF. Conclusions Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.