Epicardial irrigated radiofrequency ablation for the treatment of chronic atrial fibrillation in CABG and aortic valve patients

Objective: A significant number of patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) have chronic atrial fibrillation (AF). The aim of this study is to evaluate the safety, effectiveness and feasibility of epicardial radiofrequency ablation, used as concomitant procedure to CABG and/or AVR.

Methods: Thirty patients (mean age 67.7 years, 13 patients operated on CABG, 10 on AVR and 7 on AVR and CABG) underwent epicardial pulmonary vein (PV) isolation. Thirteen patients had paroxysmal AF and 17 permanent AF. PV isolation was performed on pump before cardiac arrest using an irrigated bipolar clamp. Rhythm was evaluated at discharge and at one and 3 month follow-up.

Results: There were no procedure related complications and no perioperative mortality. The average hospital stay was 8.6 days. No pacemaker implantations were needed. Perioperative arrhythmias affected 60% of the patients. At discharge 27 patients (90.0%) were in SR, and after one and three months postoperatively 28 patients (93.3%) were in SR. A mean follow-up of 5.6 months showed 28 patients (93.3%, including all patients with paroxysmal AF) in SR. The mean ablation time was about 3 minutes.

Conclusions: Concomitant bipolar irrigated radiofrequency ablation to CABG and/or AVR procedures was safe, effective, easy to perform and not time consuming. The benefit of the procedure regarding long term results and renouncement of anticoagulation should be investigated. It is expected that more patients should be considered for concomitant treatment of AF at the time of CABG and/or AVR.