Introduction: Recent guidelines from the European Society of Cardiology suggest that surgical ablation should be considered in patients with atrial fibrillation (AF) who present for concomitant surgically correctable disease. This is a case-matched study of radiofrequency ablation during concomitant cardiac surgery versus lone surgery on patients with persistent and long-standing permanent AF.
Methods: Surgical ablation was performed in 21 patients, 14 with persistent and 7 with long-standing permanent AF. Patients with paroxysmal AF, recent onset persistent AF (<6 months), duration >6 years or left atrial diameter >8 cm were excluded. The study patients were matched 1-2 for age, sex, type of operation, type and duration of atrial fibrillation with 42 patients operated during the same period in the same department without ablation. The catheters used deliver continuously monitored radiofrequency energy, creating linear lesions on the inside of the arrested left and/or right atrial wall. Follow up was with regular outpatients' appointments and 24-hour ECG recordings at 6 and 12 months.
Results: Sinus rhythm maintenance rate at discharge and 12-month follow up was significantly higher in the ablation group (12 months: 71% vs. 5%, p<0.01). The ablation group had significantly longer operative times. Mean ablation duration was 15.5 minutes (CI: 12-20). There were no deaths. There were no statistically significant differences in postoperative in-hospital stay, NYHA class, left atrial size, or left ventricular ejection fraction. All patients who maintained sinus rhythm during the ablation had echocardiographically confirmed left atrial systole at follow up.
Conclusion: Epicardial radiofrequency ablation in patients with persistent and long lasting permanent AF, who are being operated for concomitant cardiac surgical disease, is a safe, reproducible method with acceptable sustainability of sinus rhythm at medium-term follow up.