Very long-term results of surgical and transcatheter ablation of long-standing persistent atrial fibrillation.

Abstract

BACKGROUND:

New hybrid approaches for atrial fibrillation (AF) ablation, combining surgical and percutaneous procedures, are emerging to enhance the long-term success rate of these 2 procedures severally considered. Recent guidelines underline the need for long-term follow-up to really assess the efficacy of AF ablation.

METHODS:

From 2000 to 2002, 33 patients with long-standing persistent AF and valvular heart disease underwent valve surgery and cryoablation (pulmonary veins isolation and mitral isthmus and roof line lesions). The surgically created ablation scheme was validated with electroanatomic mapping and percutaneous radiofrequency ablation was performed in case of lesion incompleteness.

RESULTS:

In 19 of 33 patients (58%) the electroanatomic mapping showed a complete lesion scheme, which increased to 79% (26 of 33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7 ± 3.1 years, 73% (24 of 33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p = 0.048).

CONCLUSIONS:

In patients with long-standing persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of pulmonary veins isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation was highly effective in maintaining SR for a very long-term follow-up. Electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, improved the long-term efficacy.

• Authors: Fiorenzo Gaita, Elisa Ebrille, Marco Scaglione, Domenico Caponi, Lucia Garberoglio, Laura Vivalda, Alessandro Barbone, Roberto Gallotti
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 96 Issue 4 Pg. 1273-1278 (Oct 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23915587 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Atrial Fibrillation (complications, surgery)
• Cardiac Surgical Procedures (methods)
• Catheter Ablation
• Cryosurgery
• Female
• Follow-Up Studies
• Heart Valve Diseases (complications, surgery)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome