Impact of Medical Treatment on Long-Term Results after Surgical Ablation of Atrial Fibrillation in Cardiac Surgical Patients

• Published in: Annals of Thoracic and Cardiovascular Surgery 2014, Vol.20(3), pp.207-212
• Main Authors: Feyrer, Richard, Ballazhi, Fatos, Seitz, Timo, Weyand, Michael, Harig, Frank
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; antiarrhythmic drugs; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Atrial Flutter - diagnosis; Atrial Flutter - drug therapy; Atrial Flutter - etiology; Coronary Artery Bypass - adverse effects; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Electrocardiography, Ambulatory; Germany; Heart Valve Diseases - complications; Heart Valve Diseases - diagnosis; Heart Valve Diseases - surgery; HIFU; High-Intensity Focused Ultrasound Ablation - adverse effects; Humans; Prospective Studies; Recurrence; Risk Factors; surgical ablation; Time Factors; Treatment Outcome
• ISSN: 1341-1098; 2186-1005
• DOI: 10.5761/atcs.oa.12.02233

Background: The aim of this study was to evaluate the long-term outcome (4 years) of high-intensity-focused-ultrasound (HIFU) cardiac ablation, the significance of postablation antiarrhythmic drugs (AADs) and predictors of successful sinus rhythm (SR) restoration. Methods: 103 patients were prospectively enrolled in a single-center study. The preoperative atrial fibrillation (AF) type was paroxysmal in 36%, permanent in 53%, persistent in 5% and flutter in 6% patients. The left atrial diameter was 50 mm in 25. Long-term results, up to 4 years, and postablation antiarrhythmics were evaluated. Follow-up studies including 12-lead electrocardiogram (ECG) and 24-h Holter ECG obtained at 3 and 6 months in our institute, and 12, 24, and 48 months during outpatient visits. Results: No device- or procedure-related complications or deaths were observed. A pacemaker was implanted in 5% patients. Freedom from AF and flutter at 6-/12-/and 48-month visit were 66%/63%/68% for the entire population, 84%/77%/90% in patients with paroxysmal AF, 50%/46%/40% in patients with permanent AF and at any time in all 6 patients with flutter. No significant changes were noted at 2 years. Postablation results were not statistically different in patients on or not on antiarrhythmic therapy. At discharge, 53% of patients on antiarrhythmics and 55%, not on AADs were free of AF. At the 6-month visit, 66% of patients on AADs versus 69% of patients, not on AADs presented with SR, an improved outcome by 13 percentage points with AADs versus 14 percentage points without AADs (p = 0.65). Patients taking a β-blocker showed better results in restoration/maintenance of SR after 6 months. No significant difference was noted regarding the use of UltraWand. Sixty-seven percent with a left atrium (LA) diameter 50 mm. Best results were achieved in patients with paroxysmal AF and LA