Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients: expansion of the indication?

OBJECTIVES

The effectiveness of a concomitant anti-arrhythmic surgical procedure in coronary artery bypass grafting (CABG) patients with permanent atrial fibrillation (AF) was evaluated.

METHODS

This prospective study included 36 CABG patients, who had a concomitant anti-arrhythmic procedure using irrigated cooled-tip radiofrequency ablation. Follow-up included a 24 h EKG and ultrasound examination at 3, 6, 12 months.

RESULTS

Mean (SD) age was 68.7 years (8.0), left atrial diameter 44.9 mm (6.7), preoperative duration of AF 67 months (73), left ventricular ejection fraction 54% (14), euroscore 5.5 (2.6), number of distal anastomoses 3.3 (1.2), aortic cross-clamp time 90 (19)min, extracorporeal bypass time 156 (38)min. Thirty-day mortality was 2.8% (1/36). Mean (SD) follow-up was 25.3 months (17.9). Cumulative survival rates (SE) at 12 and 24 months were 0.94 (0.04) and 0.90 (0.06). Cumulative postoperative sinus rhythm (SR) rates (SE) at 6 and 12 months were 0.60 (0.08) and 0.75 (0.08). Restored bi-atrial contraction occurred in 73% (19/26) of all SR patients. As a consequence coumadine was stopped, after the 6th postoperative month, in 76% (16/21) in this subset of patients, corresponding with 44% (16/36) of all study group patients. One patient experienced a sick sinus syndrome 12 months postoperatively, for which a DDD pacemaker was implanted. Three out of five patients with a preexistent VVI pacemaker regained a stable postoperative SR with bi-atrial contraction, obviating the need of any pacemaker support.