Abstract 3376: Epicardial Ultrasonic Ablation of Atrial Fibrillation During Concomitant Cardiac Surgery is a Valid Option in Patients with Ischemic Heart Disease
Background. Atrial fibrillation has been shown to influence negatively early and long-term outcomes of patients operated on for the treatment of ischemic heart disease. Surgical therapy of atrial fibrillation concomitant to coronary bypass grafting and using epicardial, beating heart Ultrasound was assessed after a minimum 6-month follow-up.
Methods. A cohort of 98 consecutive patients with a mean age of 72 years and a primary diagnosis of ischemic heart disease had surgery for structural disease. Coronary artery bypass grafting was isolated in 42% or associated in 58% of the cases to various combinations of aortic, mitral and tricuspid surgery. A left ventricular restoration (Dor procedure) was also performed in 6 patients. 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 diameter ranged from 34 to 62 mm (mean 48±6 mm). Ablation was performed off-pump, prior to the concomitant procedure, and consisted of a single step circumferential line around the pulmonary veins created during an average 10-minute algorithm. An associated mitral line lesion was also routinely created epicardially, off-pump, with a hand-held device using the same technology. At 3, 6 and 12 month visits, patients were routinely evaluated by physical examination, 12-lead ECG, chest X-ray and 24-hour Holter. Antiarrhythmic and anticoagulant therapies were prescribed for 3 and 12 months respectively.
Results. No complications or deaths were related to the device or the procedure. There were 1 early death (1%) and 4 extra-cardiac late deaths. A pacemaker was implanted in 3 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. In the 39 patients available for the 1-year visit, 33 or 85% were free from atrial fibrillation or flutter.
Conclusion. Epicardial, off-pump, 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.