Key result
Concomitant AF ablation during CABG or AVR achieves ~79% sinus rhythm conversion versus mitral patients.
Why the study?
Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation are not routinely performed in non-mitral valve surgery such as CABG and AVR, and their effectiveness compared to mitral valve surgery is unclear.
Does a concomitant anti-arrhythmic procedure using unipolar endocardial radiofrequency ablation improve sinus rhythm conversion in patients with permanent atrial fibrillation undergoing CABG or AVR compared to mitral valve surgery?
Cohort (n=128)
Does a concomitant anti-arrhythmic procedure using unipolar endocardial radiofrequency ablation improve sinus rhythm conversion in patients with permanent atrial fibrillation undergoing CABG or AVR compared to mitral valve surgery?
Absolute Event Rate: 79% vs 71%
Concomitant anti-arrhythmic procedures for permanent atrial fibrillation are as effective in achieving sinus rhythm in patients undergoing CABG or AVR as they are in those undergoing mitral valve surgery.
May support concomitant ablation in CABG/AVR patients with permanent AF; extends mitral valve observations but leaves efficacy unconfirmed without RCTs.
OBJECTIVE: Concomitant anti-arrhythmic procedures, to treat permanent atrial fibrillation, are not routinely performed in non-mitral valve surgery, such as coronary artery bypass grafting (CABG) and aortic valve (AVR) procedures. This study evaluated the sinus rhythm (SR) conversion rate of a concomitant anti-arrhythmia procedure in non-mitral valve surgery compared to mitral valve surgery. METHODS: Between 1997 and 2003, 128 patients with a documented permanent atrial fibrillation had a concomitant anti-arrhythmic procedure using unipolar endocardial radiofrequency ablation; 65 mitral valve surgery (group I) and 63 aortic valve surgery or CABG (group II). Follow-up was complete and included standard ECG and echocardiogram at 3, 6, 12 months and each consecutive year. Stability of SR was confirmed with a 24-h ECG registration. RESULTS: Type of procedures was MVR 42 (32.8%), MVP 23 (18.0%), CABG 40 (31.2), AVR 21 (16.4%), other 2 (1.6%). Thirty-day mortality for groups I and II were 4.6% (3/65) and 3.2% (2/63). Group II patients were distinctly older (69.3 versus 64.8 years; P=0.04), but the size of the left atrium was smaller (45.9 versus 52.4mm; P=0.0001) and the aortic cross-clamp time was shorter (91 versus 99min; P=0.05). The cumulative postoperative SR percentages for the groups I and II patients at 12 months were 71 versus 79%. A bi-atrial contraction was observed in 65.6% (21/32) and 68.3% (28/41) of the groups I and II patients, who had a stable SR. The mean (SD) follow-up for groups I and II was 24.4 (19.4) and 21.0 (17.2) months. The cumulative survival rate at 1, 2 and 3 years for groups I and II were 85 versus 88%, 83 versus 85%, 79 versus 85% (log-rank test P=0.60). CONCLUSION: A concomitant anti-arrhythmic procedure in CABG and AVR patients is as effective as in mitral valve patients, although these patients tend to be older, but with a smaller left atrial size.
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Khargi et al. (2005) conducted a cohort in Permanent atrial fibrillation (n=128). Concomitant anti-arrhythmic procedure during CABG or AVR vs. Concomitant anti-arrhythmic procedure during mitral valve surgery was evaluated on Cumulative postoperative sinus rhythm (SR) percentage at 12 months. Concomitant anti-arrhythmic procedures for permanent atrial fibrillation in CABG and AVR patients achieved a 12-month sinus rhythm conversion rate of 79%, compared to 71% in mitral valve patients.
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