Quality of Life after Surgical Ablation of Persistent Atrial Fibrillation: A Prospective Evaluation.

AIM: To compare the quality of life (QoL) of patients with persistent atrial fibrillation (AF) and ischaemic heart disease after modified mini-maze (MM) procedure or pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) with patients in the control group (coronary artery bypass graft [CABG]) alone. METHODS: In this prospective randomised study, we included 95 patients with persistent AF and coronary heart disease who underwent open-heart surgery combined with intraoperative irrigated RFA (irrRFA). Patients were randomly assigned to three groups: CABG and PVI using irrRA (CABG+PVI, n=31), CABG and MM procedure using irrRA (CABG+MM, n=30), and isolated CABG (CABG alone, n=34). All patients received implantable loop recorders (ILRs). Patient QoL was assessed using the Short Form 36 (SF-36) preoperatively, and one and two years post-operatively. The study primary end point was freedom from AF one year after operation, measured by implantable loop recorders (ILRs); secondary endpoint included long-term clinical outcomes. RESULTS: No reoperations or hospital mortalities were recorded. Mean follow-up was 14.4±9.7 months. The percentages of patients free from AF determined by ILR were 80%, 86.2%, and 44.1% in the CABG+PVI, CABG+MM, and in the CABG alone groups, respectively. The QoL significantly improved in CABG+PVI and CABG+MM groups compared with CABG alone group in most domains. CONCLUSION: Effective elimination of AF during CABG surgery improves QoL in all physical health domains of the SF-36 and the role-emotional functioning domain. Thus, patients with concomitant AF and coronary heart disease may benefit from intraoperative radiofrequency ablation to prevent relapse of the arrhythmia.

Assessment of results of surgical treatment for persistent atrial fibrillation during coronary artery bypass grafting using implantable loop recorders.

OBJECTIVES: We report our experience with a modified mini-maze procedure and pulmonary vein isolation using radiofrequency energy for treating persistent atrial fibrillation during coronary artery bypass grafting (CABG). METHODS: Ninety-five patients with persistent atrial fibrillation and coronary heart disease underwent open heart surgery combined with intraoperative irrigated radiofrequency ablation. Patients were randomized into the following three groups: CABG and irrigated radiofrequency pulmonary vein isolation (CABG+PVI, n = 31); CABG and an irrigated radiofrequency modified mini-maze procedure (CABG+MM, n = 30); and isolated CABG (CABG alone, n = 34). All patients received implantable loop recorders. RESULTS: No reoperation and no hospital mortality were recorded. Mean follow-up was 14.4 ± 9.7 months. The implantable loop recorder-determined freedom from atrial fibrillation was 80% in the CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone group. CONCLUSIONS: Patients with concomitant atrial fibrillation and coronary heart disease may benefit from intraoperative ablation to prevent relapse of arrhythmia.