Combined off-pump coronary artery bypass grafting surgery and ablative therapy for atrial fibrillation: early and mid-term results.

Background: The aim of this study was to evaluate the feasibility of off-pump coronary artery bypass grafting combined with radiofrequency ablation and to compare outcomes between patients with permanent and paroxysmal atrial fibrillation (AF) in terms of restoring sinus rhythm.

Methods: Thirty-three patients underwent the combined procedure. Mean age was 62.34 +/- 8.20 years; there were 12 female and 21 male patients. Twenty-one patients were diagnosed as permanent AF (group A) and 12 had paroxysmal AF (group B). After the off-pump revascularization patients underwent pulmonary vein ablation. Rhythm was evaluated at discharge and at 6 and 12 months' follow-up. Patients in stable sinus rhythm underwent transthoracic echocardiographic examination to evaluate atrial contractility at 6 and 12 months.

Results: There was no operative mortality or major complications. The mean ablation time was 11 +/- 3.4 minutes, including multiple applications. At the end of the procedure 84.5% of patients were free of AF. Sinus rhythm was established in 56% (group A, 52%; group B, 58.3%), 70.5% (group A, 58%; group B, 83.3%), and 71% (group A, 59%; group B, 83.3%) of patients at discharge and at 6 and 12 months, respectively (p = 0.249). Biatrial contractility was detected in 71% of group A and 76% of group B patients at 6 months' follow-up. More patients in group A returned to AF during follow-up when compared with group B (p = 0.016). Female sex (odds ratio, 2.1), chronic lung disease (odds ratio, 1.40), left ventricular disfunction (p = 0.016), and hypertension (odds ratio, 2.57) emerged as risk factors for AF recurrence after ablation.

Conclusions: Concomitant off-pump coronary artery bypass grafting and bipolar radiofrequency ablation was safe and effective. These patients should be considered for adjunctive treatment at the time of off-pump revascularization.