Pre-existing RBBB and elevated LCC calcification were identified as independent predictors for PPI. These two risk factors enabled us to distinguish between patients according to their risk for PPI after TAVI. Ex vivo simulations suggested an off-centreline shift of the balloon as a possible explanation.

Concomitant surgical AF ablation showed a pacemaker implantation rate of 6.9% after 30-day follow-up. Univariate and multivariate analysis showed biatrial lesion set as the only statistically significant predictor for pacemaker implantation after surgical AF ablation.

Objectives: Concomitant surgical ablation is a safe and feasible procedure, recommended by the guidelines for patients with atrial fibrillation (AF) undergoing cardiac surgery. We performed a single-center data analysis to identify the predictors of rhythm outcome in such patients.Methods: From January 2003 to January 2012, 503 patients with persistent (n ¼ 296, 58.8%) or paroxysmal (n ¼ 207, 41.2%) AF underwent concomitant surgical AF ablation. The lesions were limited to a pulmonary vein isolation (n ¼ 76, 15.1%), a more complex left atrial lesion set (n ¼ 353, 70.2%), or biatrial lesions (n ¼ 74, 14.7%). Follow-up rhythm evaluations were based on either 24-hour Holter electrocardiograms or event recorder interrogation at 3, 6, and 12 months postoperatively. A sinus rhythm (SR) immediately postoperatively was defined as the first documented rhythm after weaning from extracorporeal circulation.Results: The mean patient age was 68.0 AE 9.5 years, and 336 (66.8%) were men. No major ablation-related complications occurred. After 1 year of follow-up, 59.9% of all patients were in SR, with significantly better results in patients with paroxysmal AF than in those with persistent AF (67.3% vs 54.8%, P ¼ .0053). Additional statistically significant factors influencing SR after 1 year were left atrial diameter (P ¼ .0019), AF duration (P ¼ .018), and immediate postoperative SR (P <.001). Regarding only patients with persistent or longstanding-persistent AF, those with biatrial lesions had significantly greater rates of conversion to SR than those with solitary left atrial ablation (SR, 64.9% vs 51.4%; P ¼ .044) after 12 months. Conclusions:The statistically significant predictors for SR after 1 year were left atrial diameter, AF duration, preoperative paroxysmal AF, immediate postoperative SR, and biatrial ablation for persistent AF.

Surgical AF ablation was safe and feasible in patients with severely reduced LVEF. The restoration of SR led to a significantly higher improvement in LVEF and alleviation of clinical heart failure symptoms, not observed if AF persisted postoperatively.