Key result
Surgical left atrial ablation yields ~20% freedom from AF at 10 years despite early success.
Why the study?
Although one-year success of concomitant AF ablation by various energy sources is extensively described, long-term rhythm stability up to ten years after concomitant left atrial ablation in cardiac surgical patients needed further evaluation.
What is the long-term rhythm stability (up to 10 years) after concomitant left atrial ablation in patients with atrial fibrillation undergoing cardiac surgery?
Cohort (n=186)
What is the long-term rhythm stability (up to 10 years) after concomitant left atrial ablation in patients with atrial fibrillation undergoing cardiac surgery?
Although concomitant surgical ablation achieves up to 70% sinus rhythm during the initial 2 postoperative years, AF progressively recurs over 10 years with only 20% remaining AF-free and 70% requiring anticoagulation.
Answers are grounded in this paper and cite their sources.
Ten-year observational rhythm data after concomitant ablation warrant caution; leaves open durability questions for randomized trials.
Objectives: Concomitant ablation therapy for AF promotes the opportunity to cure dysrhythmia. The one-year success of ablation by various energy sources are described extensively. We analyzed the rhythm stability after concomitant left atrial ablation in cardiac surgical patients (pts) during a follow-up period of up to ten years. Patients: Between 01/2003 and 07/2007 186 pts undergoing cardiac surgery (age 67 ± 10, LVEF 52 ± 12%, LA 50 ± 10 mm, chronic AF in 58%) received concomitant complete left atrial (LA) lesion set either by endomyocardial radio frequency (n = 128) or epimyocardial cryo ablation (n = 58). Indication for surgery was valvular pathology (mitral 40%; aortic 20%) or coronary disease (13%) respectively; combined procedures occurred in 23%. After surgery rhythm was annually documented by 24 hr holter ECG. Statistics included Mann-Whitney and Fisher-exact test. Results: Mean duration of follow - up was 94 ± 16 month. In this time 49 pts died (26%). 14 (7%) pts were lost to follow after 10 years. Conversion to sinus rhythm (SR) was highest at 1 and 2 years post ablation but decreased continuously thereafter. 10 years after surgical treatment 20% of pts were free from AF. Pts with intermittent AF had higher incidence of SR in early follow-up-period, however, beyond 6 years type of AF had no impact on rhythm outcome. LA diameter, preoperative duration of AF, postablative drug therapy, ablation method and performed cardiac surgery were no predictors for stable long term SR. At the end of assessment in Juli 2013 70% of all pts received anticoagulant therapy. Fig. 1 Frequency of Pts with SR in % Conclusion: Surgical concomitant ablation achieved up to 70% SR which remained stable during initial 2 postoperative years Longer follow-up, however, revealed an increasing re-appearance of AF and need to reintroduce anticoagulation. No predictors for poor longterm rhythm outcome could be identified in this cohort.
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Subbotina et al. (2014) conducted a cohort in Atrial fibrillation in cardiac surgical patients (n=186). Concomitant complete left atrial ablation (endomyocardial radiofrequency or epimyocardial cryoablation) was evaluated on Freedom from atrial fibrillation (sinus rhythm stability) at 10 years. Concomitant surgical left atrial ablation achieved up to 70% sinus rhythm in the first 2 years, but freedom from AF declined to 20% at 10 years.
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