Ablation surgery in patients with persistent atrial fibrillation: an 8-year clinical experience.

Objective: This analysis was undertaken to evaluate the results of persistent atrial fibrillation ablation procedures concomitant to open surgery and to identify risk factors for persistent atrial fibrillation recurrence.

Methods: Since 2001, a total of 325 consecutive patients with persistent atrial fibrillation (duration, 0.5-33 years) have undergone persistent atrial fibrillation ablation concomitant to open surgery by creating 2 encircling isolation lesions around the left and right pulmonary veins and a connecting lesion between both with the use of radiofrequency ablation procedures. Patients were restudied at discharge, 3 months, and 3 years after surgery.

Results: Survivals at the time of reexamination at discharge, 3 months, and 3 years were 97.8%, 96.2%, and 94.4%, respectively. Stable sinus rhythm could be documented in 72.1%, 73.9%, and 75.6% of surviving patients, respectively. Long-term persistent atrial fibrillation before surgery and a larger left atrium were predictive of postoperative persistent atrial fibrillation return (P<.001). Statistical analysis demonstrated cutoff points of 5 years for persistent atrial fibrillation and 55 mm for left atrium diameter; 89.7% of patients with persistent atrial fibrillation duration of less than 5 years and 84.5% of patients with left atrium size of 55 mm or less were in stable sinus rhythm at late follow-up. Cardiac rhythm at discharge and at 3 months was predictive of long-term rhythm prognosis (P<.001). Age, gender, concomitant diseases (eg, arterial hypertension, diabetes, renal insufficiency, or pulmonary disease), and the underlying cause of heart disease did not significantly influence the postoperative cardiac rhythm.

Conclusions: The duration of persistent atrial fibrillation and the size of the left atrium are the most reliable preoperative variables to predict the success rate of ablation concomitant to open surgery. The probability of reestablishing stable sinus rhythm is excellent when persistent atrial fibrillation duration is short and left atrium size is small.