[Mid-term results of surgical radiofrequency ablation for permanent atrial fibrillation].

Objectives: Atrial fibrillation (AF) is a common problem in cardiac surgery patients. We evaluated the mid-term results of patients who underwent open heart surgery and radiofrequency ablation (RFA).

Study Design: The study included 79 patients (53 females, 26 males; mean age 53+/-11 years; range 32 to 76 years) who underwent concomitant RFA for AF during open heart surgery under cardiopulmonary bypass. The majority of patients were in NYHA class III (n=68, 86.1%) and had (n=67, 84.8%) rheumatic heart disease. The mean preoperative AF duration was 47+/-41 months. The most frequent procedure involved the mitral valve (64 replacements, 11 reconstructions). A unipolar probe was used in 60 patients (76%) and a bipolar probe in 19 patients (24.1%). The mean follow-up period was 20.8+/-14.7 months (range 1 to 59 months).

Results: The mean perfusion and cross-clamp times were 102.4+/-15.7 min (range 48 to 171 min) and 76.1+/-25.0 min (range 27 to 145 min), respectively. In-hospital mortality occurred in two patients (2.5%) and late mortality occurred in three patients (3.8%). One patient (1.3%) required implantation of a permanent pacemaker. During discharge, 58 patients (73.4%) were in sinus rhythm, of which nine (15.3%) developed recurrent AF within a mean of 5.3+/-4.4 months (range 2 to 12 months). Transient atrial flutter was seen in three patients (3.8%). Logistic regression analysis showed no risk factor to significantly affect early or late AF recurrence. Six- and 12-month rates of AF-free rhythm were 94.3+/-3.9% and 87.6+/-5.9% for operations performed by the year 2006 and 95.2+/-3.3% and 92.2+/-4.4% afterwards, respectively (p=0.0001). There was no significant difference with respect to survival between patients discharged with AF and in sinus rhythm (p>0.05).

Conclusion: Radiofrequency ablation is increasingly performed for the treatment of AF, yielding more successful results.