title: Impact of medical treatment on long-term results after surgical ablation of atrial fibrillation in cardiac surgical patients.
abstract: BACKGROUND
  The aim of this study was to evaluate the long-term outcome (4 years) of high-intensity-focused-ultrasound (HIFU) cardiac ablation, the significance of postablation antiarrhythmic drugs (AADs) and predictors of successful sinus rhythm (SR) restoration.
  
  
  METHODS
  103 patients were prospectively enrolled in a single-center study. The preoperative atrial fibrillation (AF) type was paroxysmal in 36%, permanent in 53%, persistent in 5% and flutter in 6% patients. The left atrial diameter was <50 mm in 78 patients and >50 mm in 25. Long-term results, up to 4 years, and postablation antiarrhythmics were evaluated. Follow-up studies including 12-lead electrocardiogram (ECG) and 24-h Holter ECG obtained at 3 and 6 months in our institute, and 12, 24, and 48 months during outpatient visits.
  
  
  RESULTS
  No device- or procedure-related complications or deaths were observed. A pacemaker was implanted in 5% patients. Freedom from AF and flutter at 6-/12-/and 48-month visit were 66%/63%/68% for the entire population, 84%/77%/90% in patients with paroxysmal AF, 50%/46%/40% in patients with permanent AF and at any time in all 6 patients with flutter. No significant changes were noted at 2 years.Postablation results were not statistically different in patients on or not on antiarrhythmic therapy. At discharge, 53% of patients on antiarrhythmics and 55%, not on AADs were free of AF. At the 6-month visit, 66% of patients on AADs versus 69% of patients, not on AADs presented with SR, an improved outcome by 13 percentage points with AADs versus 14 percentage points without AADs (p = 0.65). Patients taking a β-blocker showed better results in restoration/maintenance of SR after 6 months. No significant difference was noted regarding the use of UltraWand.Sixty-seven percent with a left atrium (LA) diameter <50 mm were successfully converted into SR, vs. 48% with an LA diameter >50 mm. Best results were achieved in patients with paroxysmal AF and LA <50 mm with 81% freedom of AF.
  
  
  CONCLUSIONS
  AF treatment with HIFU ablation during concomitant cardiac surgery is a safe and effective procedure for restoring SR, especially in patients with AF and especially in patients with a smaller left atrial diameter. No significant difference was noted between the antiarrhythmic and non drug groups regarding restoration and maintaining SR; however, better results were achieved by those taking a β-blocker.
authors.affiliation: Center of Cardiac Surgery, University Hospital of Erlangen.
authors.forename: Richard
authors.initials: R
authors.lastname: Feyrer
authors.forename: Fatos
authors.initials: F
authors.lastname: Ballazhi
authors.forename: Timo
authors.initials: T
authors.lastname: Seitz
authors.forename: Michael
authors.initials: M
authors.lastname: Weyand
authors.forename: Frank
authors.initials: F
authors.lastname: Harig
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015716:Electrocardiography, Ambulatory; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents