Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients: expansion of the indication?

Objectives: The effectiveness of a concomitant anti-arrhythmic surgical procedure in coronary artery bypass grafting (CABG) patients with permanent atrial fibrillation (AF) was evaluated. Methods: This prospective study included 36 CABG patients, who had a concomitant anti-arrhythmic procedure using irrigated cooled-tip radiofrequency ablation. Follow-up included a 24 h EKG and ultrasound examination at 3, 6, 12 months. Results: Mean (SD) age was 68.7 years (8.0), left atrial diameter 44.9 mm (6.7), preoperative duration of AF 67 months (73), left ventricular ejection fraction 54% (14), euroscore 5.5 (2.6), number of distal anastomoses 3.3 (1.2), aortic cross-clamp time 90 (19) min, extracorporeal bypass time 156 (38) min. Thirty-day mortality was 2.8% (1/36). Mean (SD) follow-up was 25.3 months (17.9). Cumulative survival rates (SE) at 12 and 24 months were 0.94 (0.04) and 0.90 (0.06). Cumulative postoperative sinus rhythm (SR) rates (SE) at 6 and 12 months were 0.60 (0.08) and 0.75 (0.08). Restored bi-atrial contraction occurred in 73% (19/26) of all SR patients. As a consequence coumadine was stopped, after the 6th postoperative month, in 76% (16/21) in this subset of patients, corresponding with 44% (16/36) of all study group patients. One patient experienced a sick sinus syndrome 12 months postoperatively, for which a DDD pacemaker was implanted. Three out of five patients with a preexistent VVI pacemaker regained a stable postoperative SR with bi-atrial contraction, obviating the need of any pacemaker support.