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(Circulation. 2008;118:S78-S82.)
© 2008 American Heart Association, Inc.

Arrhythmia Surgery

Epicardial Ultrasonic Ablation of Atrial Fibrillation During Concomitant Cardiac Surgery Is a Valid Option in Patients With Ischemic Heart Disease

Mark A. Groh, MD; Oliver A. Binns, MD; Harry G. Burton, III, MD; Gerard L. Champsaur, MD; Stephen W. Ely, MD, PhD; Alan M. Johnson, MD

From the Mission Saint Joseph Hospital, Asheville, NC.

Correspondence to Mark A. Groh, MD, Asheville Cardiovascular & Thoracic Surgeons PA, 257 McDowell St, Asheville, NC 28803. E-mail mgroh{at}avlcvsurgeons.com

Background— Surgical therapy of atrial fibrillation concomitant to coronary bypass grafting using epicardial Ultrasound technology was assessed after a minimum 6-month follow-up.

Methods and Results— A cohort of 98 consecutive patients with a mean age of 72±7.58 years and a primary diagnosis of ischemic heart disease had surgery for structural disease. Coronary artery bypass grafting was isolated (n=51) or associated (n=47) with various combinations of aortic, mitral, tricuspid, and left ventricular restoration surgery. Atrial fibrillation duration ranged from 6 to 360 months (mean 71 months) and was permanent in 47 patients, paroxysmal in 34, and persistent in 17. Left atrial mean diameter was 48±6.71 mm. A circumferential ablation was performed off-pump, before the concomitant procedure, and was always associated with an epicardial mitral line lesion using the same technology. At 3-, 6-, and 12-month visits, patients were routinely evaluated by physical examination, ECG, chest X-ray, and 24-hour Holter. There were 1 early death (1%) and 4 extracardiac late deaths. A pacemaker was implanted in 4 patients. Mean follow-up time was 325 days, 2 patients being lost to follow-up. Freedom from atrial fibrillation and flutter at the 6-month visit was 84% for the entire population, 76% in patients with permanent, and 91% in patients with paroxysmal atrial fibrillation. At the 1-year visit, 85% were free from atrial fibrillation or flutter.

Conclusion— Epicardial beating heart ablation using therapeutic ultrasound is safe, reliable, and can easily treat atrial fibrillation in a difficult surgical population of patients with primary ischemic heart disease.

Key Words: atrial fibrillation • ultrasound • ischemic heart disease • coronary surgery • clinical outcomes

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