NSU-MD Faculty Articles

Epicardial ultrasonic ablation of atrial fibrillation during concomitant cardiac surgery is a valid option in patients with ischemic heart disease.

Publication Title

Circulation

Publisher

Lippincott Williams & Wilkins

ISSN

0009-7322

Publication Date

9-30-2008

Keywords

Aged, Aged, 80 and over, Atrial Fibrillation, Cardiac Surgical Procedures, Cohort Studies, Coronary Artery Bypass, Female, Follow-Up Studies, Heart Valves, Humans, Intraoperative Complications, Male, Myocardial Ischemia, Pericardium, Postoperative Complications, Treatment Outcome, Ultrasonography, Interventional

Abstract

BACKGROUND: Surgical therapy of atrial fibrillation concomitant to coronary bypass grafting using epicardial Ultrasound technology was assessed after a minimum 6-month follow-up.

METHODS AND RESULTS: A cohort of 98 consecutive patients with a mean age of 72+/-7.58 years and a primary diagnosis of ischemic heart disease had surgery for structural disease. Coronary artery bypass grafting was isolated (n=51) or associated (n=47) with various combinations of aortic, mitral, tricuspid, and left ventricular restoration surgery. Atrial fibrillation duration ranged from 6 to 360 months (mean 71 months) and was permanent in 47 patients, paroxysmal in 34, and persistent in 17. Left atrial mean diameter was 48+/-6.71 mm. A circumferential ablation was performed off-pump, before the concomitant procedure, and was always associated with an epicardial mitral line lesion using the same technology. At 3-, 6-, and 12-month visits, patients were routinely evaluated by physical examination, ECG, chest X-ray, and 24-hour Holter. There were 1 early death (1%) and 4 extracardiac late deaths. A pacemaker was implanted in 4 patients. Mean follow-up time was 325 days, 2 patients being lost to follow-up. Freedom from atrial fibrillation and flutter at the 6-month visit was 84% for the entire population, 76% in patients with permanent, and 91% in patients with paroxysmal atrial fibrillation. At the 1-year visit, 85% were free from atrial fibrillation or flutter.

CONCLUSIONS: Epicardial beating heart ablation using therapeutic ultrasound is safe, reliable, and can easily treat atrial fibrillation in a difficult surgical population of patients with primary ischemic heart disease.

DOI

10.1161/CIRCULATIONAHA.107.750927

Volume

118

Issue

14 Suppl

First Page

S78

Last Page

S82

Disciplines

Medicine and Health Sciences

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