Safety and feasibility of concomitant surgical ablation of atrial fibrillation in patients with severely reduced left ventricular ejection fraction.
OBJECTIVE
Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF <35%).


METHODS
Between July 2003 and August 2011, 59 patients with severely reduced LVEF underwent concomitant surgical AF ablation, by either left atrial (LA) lesion set or bilateral pulmonary vein isolation in patients with paroxysmal AF, and biatrial lesion set in patients with persistent AF. Follow-up echocardiography (ECG) was conducted after 12 months; rhythm monitoring was accomplished by either 24-h Holter echocardiography or event recorder monitoring.


RESULTS
The patients' mean age was 68 ± 9 years (male patients, 71%). Paroxysmal AF was present in 24 (41%) and persistent AF in 35 (59%) patients. No ablation-related adverse events occurred. The one-year survival rate was 95% without differences in patients with and without restoration of sinus rhythm (SR). The overall rate of SR was 54% after 1 year, showing a superior result in patients with preoperative paroxysmal AF compared with those with preoperative persistent AF (70 vs 41%, P < 0.001). LVEF improved from 29 ± 8% preoperatively to 39 ± 7% after 12 months of follow-up. The improvement in LVEF was significantly higher in patients with restored SR than in those with AF (16 vs 5%; P < 0.001). Only patients with restoration of SR showed a statistically significant reduction in New York Heart Association functional class at the 12-month follow-up (P = 0.0013).


CONCLUSIONS
Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany s.pecha@uke.de.
Simon
S
Pecha
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Teymour
T
Ahmadzade
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Timm
T
Schäfer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Irina
I
Subbotina
Department of Cardiology and Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Daniel
D
Steven
Department of Cardiology and Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Stephan
S
Willems
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Hermann
H
Reichenspurner
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Florian Mathias
FM
Wagner
D055011:Ablation Techniques; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000145:classification / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume
Atrial fibrillation; Heart failure; Surgical ablation