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Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences

Zusätzliche chirurgische Ablation während herzchirurgischer Eingriffe – Erfahrungen aus dem Alltag

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

Aim

Several tools have been invented for surgical atrial fibrillation (AF) ablation. In this study, we investigated the real world efficacy of intraoperative AF ablation (AFA) with radiofrequency-energy or cryo-ablation and performed an electro-anatomical remap in some patients with recurrences.

Methods

Seventy-three consecutive patients (53 male, median age of 69 ± 7 years) with history of AF underwent cardiac surgery for valve repair (74 % mitral defects, 60 % aortic defects) and/or coronary artery bypass graft procedures (56 %). During a follow-up of 23 ± 11 months after AFA we performed intensified holter-monitoring (4–7 days). Patients with symptomatic relapse of atrial arrhythmias (AA) were offered the opportunity for additional electrophysiological examination (EPE).

Results

During 23 ± 11 months after AFA, 45 patients (62 %) had recurrent AA. In eight patients we performed EPE. In all 8 cases, septal circumferential lesions could be demonstrated during mapping with discrete gaps. All lateral veins were isolated however, posteriorly deep inside the vein leaving the antral region completely untreated. Neither roof lines nor mitral isthmus lines were complete. Performing catheter ablation, all veins could be isolated and seven patients were free of any arrhythmias during follow up (9 ± 5 months) without taking antiarrhythmic drugs.

Conclusion

Surgical AF ablation may often be incomplete rendering sobering results in unselected patients. Completion of the ablation is feasible with catheter ablation with good clinical outcome.

Zusammenfassung

Zusammenfassung

Nach chirurgischer Vorhofflimmerablation zeigen sich häufig inkomplette Ablationslinien, was zu ernüchternden Ergebnissen in einem unselektierten Patientengut führt. Die Vervollständigung der Ablationslinien ist mittels Katheterablationablation mit guten klinischen Ergebnissen möglich.

Zielsetzung

Zur Durchführung der chirurgischen Ablation von Vorhofflimmern wurden verschiedenste Instrumente entwickelt. In dieser Arbeit wurde die Wirksamkeit der intraoperativen Vorhofflimmerablation mittels Radiofrequenz- bzw. Kryoablation im klinischen Alltag untersucht. Patienten mit einem Vorhofflimmerrezidiv nach herzchirurgischer Ablation wurden Katheter basiert nachuntersucht.

Methodik

Die Untersuchung umfasst 73 konsekutive Patienten (53 Männer, Durchschnittsalter 69 ± 7 Jahre) mit bekanntem Vorhofflimmern, welche sich einer Herzklappenoperation (74 % Mitralklappenfehler, 60 % Aortenklappendefekte) und/oder einer aortokoronaren Bypass Operation (56 %) unterzogen haben. Während des Nachuntersuchungszeitraums von 23 ± 11 Monaten nach intraoperativer Vorhofflimmerablation erfolgte ein intensives Monitoring (4–7 Tage Holter). Patienten mit symptomatischen Rezidiven der Rhythmusstörung wurde die Möglichkeit einer Katheter basierten Re-ablation angeboten.

Ergebnisse

Während der Nachuntersuchungszeit von 23 ± 11 Monaten erlitten 45 Patienten (62 %) ein Rezidiv einer atrialen Tachyarrhythmie. Eine elektrophysiologische Untersuchung wurde bei 8 Patienten durchgeführt. In allen 8 Fällen konnten in den Linien um die septalen Lungenvenen einzelne Lücken nachgewiesen und geschlossen werden. Alle lateralen Venen waren hingegen isoliert, jedoch in der Regel zu weit distal. Weder Linien am Vorhofdach noch am Mitralisthmus zeigten einen kompletten bidirektionalen Block. Mit Durchführung der Katheterablation konnten alle Venen isoliert werden und 7 der Patienten blieben ohne antiarrhythmische Therapie während des Nachuntersuchungszeitraums (9 ± 5 Monate) rezidivfrei.

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Authors and Affiliations

  1. Heart Center Rostock (Cardiology) University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany

    T.S. Tischer, R. Schneider, J. Lauschke & Dietmar Bänsch MD

  2. Heart Center Rostock (Cardiac Surgery) University Hospital of Rostock, Rostock, Germany

    C. Nesselmann & G. Steinhoff

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  1. T.S. Tischer
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  2. R. Schneider
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Conflict of interests

T.S. Tischer, R. Schneider, J. Lauschke, C. Nesselmann, G. Steinhoff and D. Bänsch state that there are no conflicts of interest.

Informed consent was obtained from all patients included in the study.

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Tischer, T., Schneider, R., Lauschke, J. et al. Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences. Herzschr Elektrophys 26, 291–296 (2015). https://doi.org/10.1007/s00399-015-0379-1

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  • DOI: https://doi.org/10.1007/s00399-015-0379-1

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