ABSTRACT
VISUAL ABSTRACT: http://links.lww.com/EJA/A927.
Subject(s)
Cardiac Surgical Procedures , Humans , Prospective Studies , Cardiac Surgical Procedures/adverse effects , Male , Aged , Female , Anesthesia, Conduction/methods , Emergence Delirium/prevention & control , Emergence Delirium/etiology , Emergence Delirium/diagnosis , Emergence Delirium/epidemiology , Middle Aged , Preoperative Care/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Delirium/etiology , Delirium/prevention & control , Delirium/diagnosisABSTRACT
OBJECTIVES: Concomitant cardiac surgery and radiofrequency atrial fibrillation (AF) ablation is an established procedure recommended in guidelines. However, the results have not been as good as expected. The authors therefore searched for predictive factors of success of the ablation procedure. DESIGN: The authors carried out a retrospective cohort study. SETTING: All the included patients had cardiac surgery in the Dijon University Hospital. PARTICIPANTS: One hundred sixty-three patients with AF underwent a concomitant radiofrequency ablation between January 2009 and December 2016. INTERVENTIONS: A radiofrequency device was used to isolate the pulmonary veins creating a "Box lesion." MEASUREMENTS AND MAIN RESULTS: The primary endpoint of the study was freedom from AF at 12 months with follow-up assessed by an electrocardiogram or a 24-hour recording electrocardiogram Holter. The patient's mean age was 71 ± 9 years with a sex ratio of 1.4. Sixty-six percent of patients had paroxysmal AF and 34% nonparoxysmal AF, which includes persistent and long-standing persistent AF. Sixty-one percent of patients had an AF history for more than 1 year. The mean left atrial diameter was 47 ± 10 mm. No major ablation complications related to the procedure occurred. Overall freedom from AF rate after 1-year follow-up was 60% (nâ¯=â¯98). Six patients (4%) received an additional catheter-based ablation, and 10 patients (6%) had an electrical cardioversion during the follow-up period. The authors identified preoperative paroxysmal AF (odds ratio [OR] 2.54 [1.27-5.14] pâ¯=â¯0.008) and recent history of AF, less than 1 year, (OR 1.99 [1-4.06] pâ¯=â¯0.05) as statistically significant predictors for sinus rhythm maintenance at the 12-month follow-up. At the 12-month follow-up, 64% of patients who had concomitant epicardial treatment were in sinus rhythm and 57% of patients were in sinus rhythm after endocardial treatment. There were no significant differences in rhythm outcome between epicardial and endocardial radiofrequency approach, or between surgical procedures (mitral valve replacement versus coronary artery bypass grafting). The authors could not identify in a univariate analysis a significant left atrium size cutoff upon which ablation was less likely to be successful at 12 months follow-up. CONCLUSIONS: Concomitant cardiac surgery and radiofrequency AF ablation provided freedom from AF for 60% of patients after 1-year follow-up. The authors have shown that paroxysmal AF and recent AF are predictive factors of success. Nevertheless, thorough postoperative care is necessary to improve long-term results, including the use of additional catheter ablation or cardioversion.
