Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction
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Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction. / Pecha, Simon; Ahmadzade, Teymour; Schäfer, Timm; Subbotina, Irina; Steven, Daniel; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias.
In: EUR J CARDIO-THORAC, Vol. 46, No. 1, 07.2014, p. 67-71.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction
AU - Pecha, Simon
AU - Ahmadzade, Teymour
AU - Schäfer, Timm
AU - Subbotina, Irina
AU - Steven, Daniel
AU - Willems, Stephan
AU - Reichenspurner, Hermann
AU - Wagner, Florian Mathias
N1 - © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - OBJECTIVES: Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%).METHODS: Between July 2003 and August 2011, 59 patients with severely reduced LVEF underwent concomitant surgical AF ablation, by either left atrial (LA) lesion set or bilateral pulmonary vein isolation in patients with paroxysmal AF, and biatrial lesion set in patients with persistent AF. Follow-up echocardiography (ECG) was conducted after 12 months; rhythm monitoring was accomplished by either 24-h Holter echocardiography or event recorder monitoring.RESULTS: The patients' mean age was 68 ± 9 years (male patients, 71%). Paroxysmal AF was present in 24 (41%) and persistent AF in 35 (59%) patients. No ablation-related adverse events occurred. The one-year survival rate was 95% without differences in patients with and without restoration of sinus rhythm (SR). The overall rate of SR was 54% after 1 year, showing a superior result in patients with preoperative paroxysmal AF compared with those with preoperative persistent AF (70 vs 41%, P < 0.001). LVEF improved from 29 ± 8% preoperatively to 39 ± 7% after 12 months of follow-up. The improvement in LVEF was significantly higher in patients with restored SR than in those with AF (16 vs 5%; P < 0.001). Only patients with restoration of SR showed a statistically significant reduction in New York Heart Association functional class at the 12-month follow-up (P = 0.0013).CONCLUSIONS: Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
AB - OBJECTIVES: Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%).METHODS: Between July 2003 and August 2011, 59 patients with severely reduced LVEF underwent concomitant surgical AF ablation, by either left atrial (LA) lesion set or bilateral pulmonary vein isolation in patients with paroxysmal AF, and biatrial lesion set in patients with persistent AF. Follow-up echocardiography (ECG) was conducted after 12 months; rhythm monitoring was accomplished by either 24-h Holter echocardiography or event recorder monitoring.RESULTS: The patients' mean age was 68 ± 9 years (male patients, 71%). Paroxysmal AF was present in 24 (41%) and persistent AF in 35 (59%) patients. No ablation-related adverse events occurred. The one-year survival rate was 95% without differences in patients with and without restoration of sinus rhythm (SR). The overall rate of SR was 54% after 1 year, showing a superior result in patients with preoperative paroxysmal AF compared with those with preoperative persistent AF (70 vs 41%, P < 0.001). LVEF improved from 29 ± 8% preoperatively to 39 ± 7% after 12 months of follow-up. The improvement in LVEF was significantly higher in patients with restored SR than in those with AF (16 vs 5%; P < 0.001). Only patients with restoration of SR showed a statistically significant reduction in New York Heart Association functional class at the 12-month follow-up (P = 0.0013).CONCLUSIONS: Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
KW - Ablation Techniques
KW - Aged
KW - Atrial Fibrillation/complications
KW - Echocardiography
KW - Feasibility Studies
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/classification
KW - Hospital Mortality
KW - Humans
KW - Male
KW - Retrospective Studies
KW - Stroke/epidemiology
KW - Stroke Volume
U2 - 10.1093/ejcts/ezt602
DO - 10.1093/ejcts/ezt602
M3 - SCORING: Journal article
C2 - 24446474
VL - 46
SP - 67
EP - 71
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 1
ER -
