Thorac Cardiovasc Surg 2005; 53 - V160
DOI: 10.1055/s-2005-862113

Permanent atrial fibrillation ablation surgery in CABG and aortic valve patients is at least as effective as in mitral valve disease: A 3-year experience with mono- and bipolar radiofrequency ablation surgery

S Geidel 1, J Ostermeyer 1, M Laß 1, M Geisler 1, N Kotetishvili 1, H Aslan 1, S Boczor 2, K Kuck 2
  • 1Allgemeines Krankenhaus St. Georg, Abteilung für Herzchirurgie, Hamburg
  • 2Allgemeines Krankenhaus St. Georg, Abteilung für Kardiologie, Hamburg

Objectives: Permanent atrial fibrillation (pAF) is a serious concomitant problem in patients undergoing open heart surgery (Table 1). In contrast to mitral valve (MV) surgery, concomitant pAF ablation is not routinely performed in non-MV patients, e.g. CABG and aortic valve replacement (AVR). In this study the conversion rate to stable sinus rhythm (SR) after ablation in CABG and/or AVR cases, compared to MV surgery was evaluated.

Table 1: Incidence of pAF (≥6 months) among 4.105 open heart cases

CABG and/or AVR surgery

1.7%

63 of 3.785

MV surgery

28.4%

91 of 320

Total

3.8%

154 of 4.105

p-value (exact Fisher Chi-Square)

<0.0001

Material and Methods: From February 2001 to August 2004 111 patients (Group I: CABG and/or AVR cases, n=41; Group II: MV cases: n=70) with pAF (≥6 months; duration: 5.8±5.5 years) underwent either monopolar (Group I: n=20; Group II: n=70) or bipolar (Group I: n=21) radiofrequency (RF) ablation procedures. Regular follow-up was performed 3, 6, 9, 12, 18, 24 and 36 months after surgery.

Results: Whereas preoperative characteristics of Group I and II did not reveal any significant differences of age, NYHA-classification or LVEF, a significant smaller left atrial (LA) size in Group I patients (LA-diameter: 47.4±4.7mm vs. 58.4±6.2mm) was observed (p<0.01). Early and late postoperative complications were rare in both groups. Hospital mortality was 0% in Group I and 2.8% in Group II. At discharge 63% of Group I and 65% of Group II had SR, at follow-up 70–75% of all cases and almost 80% of Group I patients were in stable SR (Table 2).

Table 2: Cases with stable SR after surgery

Follow-up (months)

Group I (n=41)

Group II (n=70)

Total (n=111)

p-value (exact Fisher Χ2)

3

74% (26 of 35)

69% (38 of 55)

71% (64 of 90)

0.640

6

79% (22 of 28)

71% (37 of 52)

74% (59 of 80)

0.597

9

79% (19 of 24)

75% (35 of 47)

76% (54 of 71)

0.774

12

79% (15 of 19)

73% (30 of 41)

75% (45 of 60)

0.755

18

73% (8 of 11)

68% (26 of 38)

69% (34 of 49)

1.000

24

63% (5 of 8)

67% (20 of 30)

66% (25 of 38)

1.000

36

100% (2 of 2)

62% (8 of 13)

67% (10 of 15)

0.524

Conclusions: Concomitant pAF ablation surgery in CABG and/or AVR is safe and at least as effective as in MV disease, presumably because severe LA enlargement is exceptionally rare in this group.