Eastern Cardiothoracic Surgical Society

Is Surgical Ablation of Atrial Fibrillation Sustained Over the Long-Term?: Review of a Single Institution s Experience
Candice Y. Lee1, Shuyan Huang1, Amber Melvin1, Collin Bowen2, Peter A. Knight1, 1University of Rochester Medical Center, Rochester, NY, 2University of Rochester, Rochester, NY

OBJECTIVE: Successful ablation of atrial fibrillation (AF) remains challenging. We reviewed our use of high-intensity focused ultrasound for AF ablation to determine its long-term effectiveness and safety.

METHODS: Between 5/2007 and 6/2012, 61 patients who underwent cardiac surgery with concomitant MAZE procedure using this ablation system were included in an IRB-approved study involving retrospective chart review, telephone interview, and AFEQT questionnaire.

RESULTS: The mean age was 71.8 8.2 years. Mean pre-operative AF duration was 30.5 months–49% paroxysmal, 18.9% persistent, and 32.1% long-term persistent. Concomitant cardiac procedures included isolated valve surgery (27), isolated coronary artery bypass grafting (CABG) (17), CABG + valve surgery (11), and other (6). Off-pump pulmonary vein isolation with or without creation of a mitral isthmus line was performed using the ablation system, prior to initiation of cardiac repair. No device-related complications occurred. Peri-operative adverse events included heart block (6), re-exploration for bleeding (2), prolonged ventilator dependence (2), renal failure (2), stroke (1), and death (1). Rhythm monitoring was captured by Holter monitor, electrocardiogram, or pacemaker recordings. Freedom from AF (FAF) was 83.1% at six-, 78.7% at 12-, 71% at 24-, 67.3% at 36-, and 48.8% at 48-months follow-up. Median FAF was 45.9 months. On AFEQT questionnaires, patients reported low AF symptom interference with daily activities and high treatment satisfaction.

CONCLUSIONS: Our FAF results at six and 12 months were consistent with prior studies; however, FAF was poorly sustained long-term. Despite marginal long-term success rates with this modality, patients reported minimal AF symptoms and high treatment satisfaction.