Abstract 13567: Surgical Therapy for Heart Failure Combining Structural Heart Repair with Left Atrial Ablation is Beneficial in Elderly Patients With Severe Cardiomyopathy and Atrial Fibrillation
Atrial fibrillation (AF) is a marker and mortality risk factor in patients with compromised left ventricular function. We tested the hypothesis that surgical ablation at the time of structural heart repair in patients with severe cardiomyopathy and AF would improve morbidity and mortality in the elderly. We reviewed a cohort of 125 consecutive patients with an ejection fraction (EF) less than 40% who underwent corrective cardiac surgery and concomitant AF ablation. The group was composed of 88 male and 37 female patients with a mean age of 70.8 +9.6 years, who underwent surgery while in AF. Mean duration of AF was 60 months and AF classification was long standing persistent in 56%, persistent in 19.5% and paroxysmal in 24.5%. Mean left atrial diameter was 50.7mm. Patients had a mean EF of 30.2 ± 8.7%, 95%CI 28.7 to 31.9%. Advanced heart failure was present in 86% of the patients who were in either NYHA Class III or IV. Prior to cardiac repair, epicardial off-pump cardiac ablation was performed on the beating heart. The lesion set resulted in posterior left atrial isolation in conjunction with the creation of the mitral isthmus line. Concomitant surgical procedures were CABG (37), isolated valve repair (31), combined CABG and valve surgery (42), Dor procedure (5) and miscellaneous (10). Adverse peri-operative events included one death, 2 re-explorations for bleeding and 5 episodes of renal insufficiency. There were no permanent strokes. Over a mean follow-up of 30.6 months, with 2 patients lost to follow-up, there were 18 late deaths, of which 8 were cardiac. Long-term rhythm monitoring was carried out by 24 hour Holter, 7 day Holter or pacemaker interrogation at 6 months and yearly thereafter. Freedom from AF or atrial flutter was 79.8% at 6 months, 82% at one year, and 76.4% at 2 years. At last follow up, 12% of patients were on antiarrhythmic medications. Actuarial survival was 90.3% at 12 months, 85.8% at 24 months and 83% at 36 months. In elderly patients with severely compromised left ventricular function, restoration and maintenance of sinus rhythm through epicardial AF ablation performed at the time of structural heart repair has a positive impact on both survival and morbidity. Our study indicates these benefits persist through 3 years after surgery
- © 2010 by American Heart Association, Inc.