Abstract 21270: Ten Year Experience with Surgical Ablation for Atrial Fibrillation
Introduction: Surgical ablation has replaced prior ”cut and sew” procedures and is commonly performed in patients with atrial fibrillation (AF) undergoing concomitant cardiac procedures. We describe our ten year experience with surgical ablation of AF with the goal of identifying variables associated with rhythm success.
Methods: An analysis was performed of all patients undergoing surgical ablation of AF at our institution from October 1999 to October 2009. Preoperative and postoperative data were collected retrospectively and intraoperative data collected prospectively.
Results: 701 patients underwent surgical ablation of AF over the ten year period. Average age was 65 years and 59% had persistent AF. Six percent of patients had an isolated ablation and 62% of these underwent a minimally invasive approach. Postoperative cerebrovascular events occurred more frequently if the left atrial appendage was not amputated (closed or left alone [3.0% vs 0%; p=.024]). Energy modalitiy (radiofrequency [30%], microwave [37%], laser [21%], cryoablation [12%]) and lesion set (pulmonary vein isolation [PVI] alone [49%], PVI plus additional left sided lesions [36%], biatrial lesion set [15%]) did not correlate with rhythm success. Rhythm success was 60% at 12+ months, 58% at 36+ months, and 52% at 60+ months. Independent predictors of rhythm failure at 12+ months in multivariate analysis included increasing age, a history of persistent AF, diabetes, and decreasing ejection fraction (table 1).
Conclusion: In our ten year experience, surgical ablation is a safe and effective procedure for the treatment of AF with durable results up to 5+ years. With current surgical advances, ablation may be offered to patients with lone AF via a minimally invasive approach. Although factors commonly believed to affect rhythm success such as left atrial size and lesion set did not in the current study, others such as persistent AF and diabetes did and warrant further analysis.
- © 2010 by American Heart Association, Inc.