Key result
Surgical RF ablation achieves sinus rhythm in ~90% of patients with small left atria.
Why the study?
Does radiofrequency ablation combined with amiodarone improve sinus rhythm maintenance in patients with permanent atrial fibrillation undergoing open heart surgery?
Cohort (n=106)
Does radiofrequency ablation combined with amiodarone improve sinus rhythm maintenance in patients with permanent atrial fibrillation undergoing open heart surgery?
p-value: p=0.033, 0.002, 0.006
Radiofrequency ablation combined with amiodarone is an effective strategy for restoring sinus rhythm in patients with permanent AF undergoing open heart surgery, particularly in those with preoperative left atrial diameter <56 mm.
LA size may guide expectations for surgical AF ablation success; leaves open whether size-based thresholds warrant prospective validation before practice change.
OBJECTIVE: In our population permanent atrial fibrillation (pAF) is a frequent concomitant problem in patients undergoing open heart surgery. A 3-year experience with a treatment strategy using mono- and bipolar radiofrequency (RF) ablation procedures in a heterogeneous group of patients is reported. METHODS: In a prospective analysis the incidence of pAF among all patients undergoing open heart surgery in our department between February 2001 and July 2004 was evaluated. In a second step a selective group of 106 patients with pAF (primary mitral: n=63; aortic: n=24; CABG: n=16; aortic+mitral: n=3) underwent either monopolar (n=86) or bipolar (n=20) RF ablation procedures creating two encircling isolation lesions around the left and the right pulmonary veins (PVs) and a connection line between both. In addition amiodarone was given for 3 months after surgery. Regular follow-ups were performed 3, 6, 9, 12, 18, 24 and 36 months after surgery. RESULTS: The incidence of pAF in the total group of 4.110 patients was 3.6%. While the rate was low in cases without severe heart valve disease (1.1%), a significantly higher presence of pAF in patients scheduled for heart valve surgery (10.3%) was observed (P<0.0001). The incidence was 30-39% in patients with degenerative and rheumatic mitral valve (MV) disease, and further particularly high in the older aged compared to younger patients (4.2-8.3% at 70-99 years; P<0.001). Hospital mortality after combined open heart and RF ablation surgery was 1.9%. Whereas patients with small left atrial size (LA-diameters <56 mm; n=59) had SR in almost 90% at follow-up, LA enlargement (LA-diameter > or =56 mm; n=47) was associated with a significant risk of persisting pAF after surgery (P=0.033, 0.002 and 0.006 at 3, 6 and 9 months follow-up). CONCLUSION: The use of RF ablation procedures in combination with amiodarone therapy represents a safe and efficient option to cure pAF during open heart surgery in a selective group of patients. The preoperative LA size was of significant importance for the outcome in this investigation.
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Geidel et al. (2004) conducted a cohort in permanent atrial fibrillation (n=106). Monopolar or bipolar radiofrequency ablation was evaluated on Sinus rhythm at follow-up (p=0.033, 0.002, 0.006). Radiofrequency ablation during open heart surgery achieved sinus rhythm in almost 90% of patients with small left atria (<56 mm), while LA enlargement significantly increased the risk of persisting pAF.
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