Permanent Atrial Fibrillation Ablation Surgery in CABG and Aortic Valve Patients is at Least as Effective as in Mitral Valve Disease

Abstract

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

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

“…More recent retrospective studies have documented success using a variety of different technologies, most commonly bipolar RF ablation, for the treatment of AF with concomitant mitral or other cardiac operations [682,[698][699][700][701][702][703][704][705][706]. In these series, success rates have varied between 65% and 95% at 6 months [706].…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…1345 The application of bipolar RF clamps to perform PVI has shown variable 50%–89% 1-year success superior to AAD alone in patients with paroxysmal and persistent AF. 1346,1347,1348,1349,1350 A recent meta-analysis of 16 RCTs of surgical ablation and concomitant operations evaluated predominantly mitral operations, but included both AVR and CABG operations. 1333 There were no significant differences in mortality, stroke, or pacemaker requirement between surgical ablation compared with no ablation; however, the surgical ablation groups demonstrated superior 1-year freedom from AF in AVR and AVR+CABG.…”

Concomitant Ablation of Atrial Fibrillation: Are Results Associated With Surgeon's Experience?

“…Higher rates of up to 24% may be due to wider indications, 5 based on the fact that atrial pacing algorithms can prevent atrial arrhythmias 21 . Compared to others, 4 the number of patients undergoing DC shock cardioversion of recurrent AF early postoperatively was small in this study. Similar to the Dresden group, 5 we have experienced superiority in delaying cardioversion to the sixth to tenth postoperative week.…”

“…Its progressive nature results from electrical, contractile, and structural remodelling of the atria induced by the underlying heart disease and the arrhythmia itself 1 . AF is associated with an increased morbidity and mortality, and it affects a significant number of patients necessitating valvular or coronary heart surgery 2‐5 …”