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J Thorac Cardiovasc Surg 2005;129:1322-1329
© 2005 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Center for Atrial Fibrillation and the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
b Department of Qualitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio.
c Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23–26, 2004.
Received for publication June 23, 2004; revisions received October 21, 2004; accepted for publication December 15, 2004. * Address for reprints: A. Marc Gillinov, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F24, 9500 Euclid Ave, Cleveland, OH 44195. (Email: gillinom{at}ccf.org).
OBJECTIVES: In studying cardiac surgical patients undergoing atrial fibrillation ablation with bipolar radiofrequency, we sought to (1) quantify the time-related prevalence of atrial fibrillation postoperatively and identify its risk factors and (2) determine time-related ablation failure and its risk factors.
METHODS: From November 2001 to January 2004, 513 patients underwent atrial fibrillation ablation (bipolar radiofrequency alone or with cryothermy) and other cardiac operations. Rhythm documented on 3495 postoperative electrocardiograms was used to estimate the prevalence of and risk factors for atrial fibrillation across time. Ablation failure was defined as occurrence of atrial fibrillation any time beyond 6 months after operation.
RESULTS: Prevalence of postoperative atrial fibrillation peaked at about 1 month, decreased to 13% at 6 months, and gradually increased thereafter. Risk factors associated with increased prevalence varied by time period and included older age (P = .004) for early occurrence, lesion set in permanent atrial fibrillation (P = .02) for late occurrence, and larger left atrial diameter (P = .02) and permanent atrial fibrillation (P < .0001) for occurrence across the entire time span. Freedom from ablation failure was 72% at 12 months. Risk factors for ablation failure included lesion set in permanent atrial fibrillation (P = .001), longer duration of atrial fibrillation (P = .01), and larger left atrial diameter (P = .03).
CONCLUSIONS: Bipolar radiofrequency enables extension of ablation to most cardiac surgical patients with atrial fibrillation. Recurrence is influenced by the type and duration of atrial fibrillation, choice of lesion set in permanent atrial fibrillation, and left atrial size. Early operation, careful choice of lesion set, and left atrial reduction might enhance results.
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