Abstract 20995: Early and Mid-term Results of Ablation for Atrial Fibrillation (AF) Concomitant to Isolated CACB Surgery
Objective: Results of surgical AF ablation in combination with isolated CABG were evaluated with regard to different AF pathologies and applied energy sources.
Methods: During 2002–2009 a total of 268 patients received isolated CABG and surgical AF therapy. For endocardial approach cryotechnology and for epicardial approach predominantely bipolar radiofrequency was applied. All patients received 24h Holter before discharge and after 12 months. During yearly telephone follow-up all medication and clinical symptoms were determined accompanied by SF-12 and AF severity score questionnaires.
Results: Age was 70.6±6.7y with 20.0% female. Ejection fraction was 54.4±12.5%. Paroxysmal AF was present in 47.3%, 32.5% had preoperatively oral anticoagulation. LA size was 46.8±8.2mm, AF history was 3.7±3.1y. 2.9±0.9 distal anastomoses were performed with 96.2% LIMA and 31.5% BIMA use and 28.0% OPCAB. Endocardial approach was used in 33.8%. Hospital mortality was 4.2% and varied significant between paroxysmal (1.6%) vs. persistent AF (6.6%, p=0.03). SR at discharge was present in 86.2% of paroxysmal and 63.5% of persistent AF (p<0.01) with comparable results for radiofrequency vs. cryo in paroxysmal (88.0% vs. 86.2%, p=0.56), but better success in cryotechnology in persistent AF (73.1 vs. 60.5%, p=0.04). 1- and 3-year survival was 92.3% and 88.4%, respectively with significant worse survival in persistent AF (p=0.017), but no difference between energy sources. At 1-year 88.3% of paroxysmal AF had SR without difference in energy source while cryoenergy had better results in persistent AF (SR in 63% vs. 52.1%). QoL and AF burden was comparable between different energy sources. Freedom of anticoagulation was 57.2% of paroxysmal 55% of persistent AF patients. AF burden and quality of life was comparable between the groups.
Conclusions: Concomitant AF ablation for atrial fibrillation in ischemic heart disease is highly effective especially in paroxysmal AF. For patients with persistent AF endocardial cryoablation is more successful but is associated with a higher perioperative adverse event rate.
- © 2010 by American Heart Association, Inc.