Key result
Intraoperative left atrial RF ablation linked to ~7-fold greater stable sinus rhythm vs surgery alone.
Why the study?
Intraoperative left atrial radiofrequency ablation has been suggested as an effective surgical treatment for atrial fibrillation, but its outcomes require verification in a controlled multicenter trial.
Does intraoperative left atrial radiofrequency ablation improve the restoration of sinus rhythm in patients with atrial fibrillation undergoing cardiac surgery?
Cohort (n=130)
Yes
Does intraoperative left atrial radiofrequency ablation improve the restoration of sinus rhythm in patients with atrial fibrillation undergoing cardiac surgery?
Absolute Event Rate: 81% vs 11%
p-value: p=<0.0001
Intraoperative left atrial radiofrequency ablation during cardiac surgery is highly effective at restoring and maintaining sinus rhythm in patients with atrial fibrillation.
Intraoperative left atrial RF ablation was associated with higher sinus rhythm rates; supports randomized trials before changing surgical practice.
INTRODUCTION: Intraoperative left atrial radiofrequency (RF) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation (AF). The aim of this study was to verify the outcome of this technique in a controlled multicenter trial. METHODS AND RESULTS: One hundred three consecutive patients (39 men and 65 women; age 62 +/- 11 years) affected by AF underwent cardiac surgery and RF ablation in the left atrium (RF group). The control group consisted of 27 patients (6 men and 21 women; age 64 +/- 7 years) with AF who underwent cardiac surgery during the same period and refused RF ablation. Mitral valve disease was present in 89 (86%) and 25 (92%) patients, respectively (P = NS). RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins, a lesion connecting the previous lines, and a lesion connecting the line encircling the left veins to the mitral annulus. Upon discharge from the hospital, sinus rhythm was present in 65 patients (63%) versus 5 patients (18%) in the control group (P < 0.0001). Mean time of cardiopulmonary bypass was longer in the RF group (148 +/- 50 min vs 117 +/- 30 min, P = 0.013). The complication rate was similar in both groups, but RF ablation-related complications occurred in 4 RF group patients (3.9%). After a mean follow-up of 12.5 +/- 5 months (range 4-24), 83 (81%) of 102 RF group patients were in stable sinus rhythm versus 3 (11%) of 27 in the control group (P < 0.0001). The success rate was similar among the four surgical centers. Atrial contraction was present in 66 (79.5%) of 83 patients in the RF group in sinus rhythm. CONCLUSION: Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation-related complications can occur. During follow-up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients.
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Mantovan et al. (2003) conducted a cohort in Atrial fibrillation (n=130). Intraoperative left atrial radiofrequency (RF) ablation vs. Cardiac surgery without RF ablation was evaluated on Stable sinus rhythm at follow-up (p=<0.0001). Intraoperative left atrial radiofrequency ablation during cardiac surgery was associated with a higher rate of stable sinus rhythm at 12.5 months compared to surgery alone (81% vs 11%, P<0.0001).
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