title: Rhythm course over 5 years following surgical ablation for atrial fibrillation.
abstract: OBJECTIVE
  Reporting methods for surgical ablation (SA) of atrial fibrillation (AF) were standardized by the Heart Rhythm Society Guidelines, stating that results should be reported only for the first 2 years following SA. The purpose of this study was to assess the outcome of SA over 5 years and determine predictors for success over that period.
  
  
  METHODS
  Data were collected prospectively for all SA (n=787). Rhythm was verified by electrocardiogram and Holter monitoring at 3, 6, 9, 12, 18 and 24 months and yearly thereafter. Patients with rhythm status available at 2 and 5 years were included in the main analyses (n=137). Multivariate logistic regression was used for predictors of normal sinus rhythm (NSR). Receiver operating curves compared 2- and 5-year predicted probability against observed rhythm status by year.
  
  
  RESULTS
  Return to NSR at 2 years was 88% (80% off antiarrhythmic drugs) and at 5 years was 85% (71% off antiarrhythmic drugs). The majority of patients (64%) had stable NSR over 5 years. The only predictor for 2-year NSR was smaller left atrial size (odds ratio [OR]=0.40, P=0.044). Predictors for 5-year NSR were smaller left atrial size (OR=0.28, P=0.002), age (OR=0.91, P=0.031) and length of hospital stay (OR=0.85, P=0.026).
  
  
  CONCLUSIONS
  This study demonstrated stable results of SA for AF over time with somewhat different predictors for 2- and 5-year NSR in a group of patients with complete follow-up at both time points. Accurate models to determine predictors for success of SA more than 2 years after surgery are essential to better understand long-term outcome for patients with AF.
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA, USA niv.ad@inova.org.
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA, USA.
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA, USA.
authors.forename: Lori E
authors.initials: LE
authors.lastname: Stone
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA, USA.
authors.forename: Graciela
authors.initials: G
authors.lastname: Pritchard
authors.affiliation: Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, VA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Henry
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Long-term follow-up; Rhythm; Surgical ablation