Predictors of Rhythm Outcome in Patients Undergoing Concomitant AF Ablation: A Single-Center Experience of More than 1,000 Patients

Background: Concomitant surgical ablation is a safe and feasible procedure, recommended in guidelines for patients with atrial fibrillation (AF) undergoing cardiac surgery. We performed a single-center data analysis to identify predictors of rhythm outcome in a large patient cohort.

Method: Between January 2003 and August 2020, a total of 1,409 patients underwent concomitant surgical AF ablation. A total of 1,011 patients (age 75 ± 11; 64.9% male) with paroxysmal (n = 533, 52.7%) or persistent/longstanding persistent (n = 464, 45.9%) AF had a 1-year follow-up and were included in this retrospective analysis.

The lesions were either limited to a pulmonary vein isolation (n = 266, 26.3%), a more complex left atrial lesion set (n = 518, 51.2%), or biatrial lesions (n = 215, 21.3%). Follow-up rhythm evaluations were based on either 24-hour Holter ECG or event recorder interrogation at 12 months postoperatively.

Results: Mean patients age was 75 ± 11 years, 656 (64.9%) were men. There were no major ablation-related complications. After 1-year follow-up freedom from AF was 66.9%, showing significantly better results in patients with paroxysmal AF compared with those with persistent or longstanding persistent AF (75.4 vs. 57.2%, p ≤ 0.001). Additional statistically significant factors influencing freedom from AF after 1 year were immediate postoperative SR (p < 0.001), and shorter duration of AF (p = 0.014). A double valve procedure turned out to be a negative predictive value for freedom from AF after 12 months (p = 0.036).

Conclusion: Mean patients age was 75 ± 11 years, 656 (64.9%) were men. There were no major ablation-related complications. After 1-year follow-up freedom from AF was 66.9%, showing significantly better results in patients with paroxysmal AF compared with those with persistent or longstanding-persistent AF (75.4% vs. 57.2%, p ≤ 0.001). Additional statistically significant factors influencing freedom from AF after 1 year were immediate postoperative SR (p < 0.001), and shorter duration of AF (p = 0.014). A double valve procedure turned out to be a negative predictive value for freedom from AF after 12 months (p = 0.036).

Publication History

Article published online:
03 February 2022