Key result
Biatrial surgical ablation is linked to ~33% higher 12-month freedom from persistent AF versus left-atrial ablation.
Why the study?
Previous studies on concomitant surgical ablation for persistent AF reported varying success rates mostly based on discontinuous monitoring, lacking continuous rhythm assessment.
Does a biatrial lesion set improve freedom from AF compared to a left-atrial lesion set in patients undergoing concomitant surgical ablation for persistent AF?
Cohort (n=132)
Does a biatrial lesion set improve freedom from AF compared to a left-atrial lesion set in patients undergoing concomitant surgical ablation for persistent AF?
In patients undergoing concomitant surgical ablation for persistent AF, a biatrial lesion set significantly improved freedom from AF at 12 months compared to a left-atrial lesion set, as assessed by continuous ILR monitoring.
Answers are grounded in this paper and cite their sources.
May support biatrial lesion sets in persistent AF surgery; hypothesis-generating and requires randomized confirmation before practice change.
Objectives: Various lesion sets and different success rates have been reported in patients receiving concomitant surgical ablation for atrial fibrillation (AF). However, most of these results have been obtained by discontinuous monitoring. We report results using continuous implantable loop recorder (ILR) rhythm monitoring to more accurately compare the efficacy of a left- versus a biatrial lesion set to treat patients with persistent AF. Methods: Between 07/2008 and 12/2011, 66 patients with persistent or long-standing persistent AF underwent concomitant surgical AF ablation with a biatrial lesion set and subcutaneous ILR implantation. Results and outcomes were compared with a propensity score matched cohort of 66 patients with a left-atrial lesion set and ILR implantation. ILR interrogation was performed at 3, 6, and 12 months follow-up. Results: Mean patient age was 70.2 ± 7.4 years, 70.3% were male. No major ablation-related complications occurred. The overall one-year survival rate was 94.8% without statistically significant differences between the two groups. The overall rate of freedom from AF was 57.3% and 64.4% after 3 and 12 months follow-up respectively. After 3 months, patients in the biatrial ablation group had a slightly higher rate of freedom from AF (63.6% versus 52.3% p = 0.22), however it did not reach statistical significance. At 12 months follow-up, in patients with a biatrial lesion set, a statistically significant higher rate of freedom from AF was observed (74.4% versus 55.8%; p = 0.026). The mean AF burden of all patients was 15.1% ± 12.5% in biatrial- and 21.2% ± 14.4% in left-atrial group 12 months postoperative ( p = 0.03). Conclusions: Continuous rhythm monitoring by subcutaneous ILR implantation was safe and feasible. In patients undergoing biatrial ablation, a significantly higher rate of freedom from AF was observed at 12 months follow-up. We therefore recommend biatrial ablation in patients with persistent- or longstanding persistent AF.
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Pecha et al. (2015) conducted a cohort in Persistent or long-standing persistent atrial fibrillation (n=132). Biatrial lesion set vs. Left-atrial lesion set was evaluated on Freedom from AF at 12 months (p=0.026). A biatrial lesion set during surgical ablation for persistent AF was associated with a higher rate of freedom from AF at 12 months compared to a left-atrial lesion set (74.4% vs 55.8%; p=0.026).
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