Key result
Surgical ablation for atrial fibrillation resulted in 85% of patients maintaining normal sinus rhythm at 5 years, with smaller left atrial size predicting success (OR 0.28; P=0.002).
Why the study?
Does surgical ablation maintain normal sinus rhythm over 5 years in patients with atrial fibrillation?
Cohort (n=137)
Does surgical ablation maintain normal sinus rhythm over 5 years in patients with atrial fibrillation?
Surgical ablation for atrial fibrillation provides stable maintenance of normal sinus rhythm up to 5 years, extending evidence beyond the standard 2-year reporting guidelines.
May support surgical ablation for durable AF rhythm control; leaves open confirmation in randomized trials beyond 2-year data.
OBJECTIVES: Reporting methods for surgical ablation (SA) of atrial fibrillation (AF) were standardized by the Heart Rhythm Society Guidelines, stating that results should be reported only for the first 2 years following SA. The purpose of this study was to assess the outcome of SA over 5 years and determine predictors for success over that period. METHODS: Data were collected prospectively for all SA (n=787). Rhythm was verified by electrocardiogram and Holter monitoring at 3, 6, 9, 12, 18 and 24 months and yearly thereafter. Patients with rhythm status available at 2 and 5 years were included in the main analyses (n=137). Multivariate logistic regression was used for predictors of normal sinus rhythm (NSR). Receiver operating curves compared 2- and 5-year predicted probability against observed rhythm status by year. RESULTS: Return to NSR at 2 years was 88% (80% off antiarrhythmic drugs) and at 5 years was 85% (71% off antiarrhythmic drugs). The majority of patients (64%) had stable NSR over 5 years. The only predictor for 2-year NSR was smaller left atrial size (odds ratio [OR]=0.40, P=0.044). Predictors for 5-year NSR were smaller left atrial size (OR=0.28, P=0.002), age (OR=0.91, P=0.031) and length of hospital stay (OR=0.85, P=0.026). CONCLUSIONS: This study demonstrated stable results of SA for AF over time with somewhat different predictors for 2- and 5-year NSR in a group of patients with complete follow-up at both time points. Accurate models to determine predictors for success of SA more than 2 years after surgery are essential to better understand long-term outcome for patients with AF.
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Ad et al. (2014) conducted a cohort in Atrial fibrillation (n=137). Surgical ablation was evaluated on Return to normal sinus rhythm (NSR) at 5 years. Surgical ablation for atrial fibrillation resulted in 85% of patients maintaining normal sinus rhythm at 5 years, with smaller left atrial size predicting success (OR 0.28; P=0.002).
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