title: Atrial fibrillation ablation induces reverse remodelling and impacts cardiac function.
abstract: OBJECTIVE
  Atrio-ventricular anatomo-functional response to successful surgical atrial fibrillation (AF) ablation has been poorly investigated. Determinants of AF recurrence following surgical ablation are still debated.
  
  
  METHODS
  Sixty-nine patients underwent AF ablation during major cardiac surgery. Main outcomes were clinical and echocardiographic results after monopolar and/or bipolar ablation were recorded. Secondary outcomes were freedom from AF, rehospitalization and congestive heart failure (CHF) at follow-up. Predictors of AF-recurrence were evaluated.
  
  
  RESULTS
  Fifty-three patients (76.8%) were in sinus rhythm (SR) at 31.4±10.6 months of mean follow-up. Overall freedom from AF-recurrence was 61.4±6.6%, from hospital readmission 89.9±3.6%, from CHF 91.9±5.05%. Compared to AF-patients, SR-patients demonstrated better freedom from re-hospitalization (98.1±1.9% vs. 62.5±12.1%; P=0.0001) and CHF (94.7±5.1% vs. 77.8±13.9%; P=0.006). At follow-up SR-patients demonstrated atrial (preoperative 5.9±1.2 cm vs. follow-up 5.2±1.0; P=0.01) and ventricular reverse remodelling (preoperative LVDd 5.8±1.6cm vs. follow-up 5.0±1.3 cm; P=0.002 - preoperative LVDs 4.2±1.8 cm vs. follow-up 3.8±1.2 cm; P=0.045). E/A ratio was normal in 90.6% of SR-patients (69.6% of the total population of the study). TDI at the level of the left lateral annulus showed an improved left ventricular systole (Sm), and diastole (Em, E/Em) for SR-patients compared to AF-patients (Sm 9.30±1.66 vs. 7.81±1.41, P=0.001; Em: 10.55±1.87 vs. 7.44±0.40, P=0.001; E/Em: 0.06±0.02 vs. 0.11±0.05, P=0.0001). Preoperative atrial diameter (OR=23.9; P=0.002) and tricuspid insufficiency at follow-up (OR=3.5; P=0.008) were independent predictors of AF-recurrence. Neither etiology, nor duration of AF, nor even ablation technique influenced SR recovery (P=NS for all measurement).
  
  
  CONCLUSIONS
  Radiofrequency AF ablation achieves 76.8% of SR recovery at follow-up. Maintenance of SR improves clinical, haemodynamic and echocardiographic results.
authors.affiliation: Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Santarpino
authors.forename: A S
authors.initials: AS
authors.lastname: Rubino
authors.forename: F
authors.initials: F
authors.lastname: Onorati
authors.forename: A
authors.initials: A
authors.lastname: Curcio
authors.forename: D
authors.initials: D
authors.lastname: Torella
authors.forename: L
authors.initials: L
authors.lastname: Tucci
authors.forename: C
authors.initials: C
authors.lastname: Indolfi
authors.forename: A
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged