title: Epicardial ultrasonic ablation of atrial fibrillation during concomitant cardiac surgery is a valid option in patients with ischemic heart disease.
abstract: BACKGROUND
  Surgical therapy of atrial fibrillation concomitant to coronary bypass grafting using epicardial Ultrasound technology was assessed after a minimum 6-month follow-up.
  
  
  RESULTS
  A cohort of 98 consecutive patients with a mean age of 72+/-7.58 years and a primary diagnosis of ischemic heart disease had surgery for structural disease. Coronary artery bypass grafting was isolated (n=51) or associated (n=47) with various combinations of aortic, mitral, tricuspid, and left ventricular restoration surgery. Atrial fibrillation duration ranged from 6 to 360 months (mean 71 months) and was permanent in 47 patients, paroxysmal in 34, and persistent in 17. Left atrial mean diameter was 48+/-6.71 mm. A circumferential ablation was performed off-pump, before the concomitant procedure, and was always associated with an epicardial mitral line lesion using the same technology. At 3-, 6-, and 12-month visits, patients were routinely evaluated by physical examination, ECG, chest X-ray, and 24-hour Holter. There were 1 early death (1%) and 4 extracardiac late deaths. A pacemaker was implanted in 4 patients. Mean follow-up time was 325 days, 2 patients being lost to follow-up. Freedom from atrial fibrillation and flutter at the 6-month visit was 84% for the entire population, 76% in patients with permanent, and 91% in patients with paroxysmal atrial fibrillation. At the 1-year visit, 85% were free from atrial fibrillation or flutter.
  
  
  CONCLUSIONS
  Epicardial beating heart ablation using therapeutic ultrasound is safe, reliable, and can easily treat atrial fibrillation in a difficult surgical population of patients with primary ischemic heart disease.
authors.affiliation: Asheville Cardiovascular & Thoracic Surgeons PA, 257 McDowell St, Asheville, NC 28803, USA. mgroh@avlcvsurgeons.com
authors.forename: Mark A
authors.initials: MA
authors.lastname: Groh
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Binns
authors.forename: Harry G
authors.initials: HG
authors.lastname: Burton
authors.forename: Gerard L
authors.initials: GL
authors.lastname: Champsaur
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Ely
authors.forename: Alan M
authors.initials: AM
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery*; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000592:standards