Dilated left atrium as a predictor of late outcome after pulmonary vein isolation concomitant with aortic valve replacement and/or coronary artery bypass grafting

Abstract

In patients with paroxysmal AF related to aortic valve disease and/or coronary artery disease, a dilated left atrium (≥45 mm) was associated with inferior AF- and event-free survival after PVI, accompanied by persistent abnormalities in cardiac and haemodynamic function. These findings may assist patient selection for PVI during AVR and/or CABG.

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“… 1345 The application of bipolar RF clamps to perform PVI has shown variable 50%-89% 1-year success superior to AAD alone in patients with paroxysmal and persistent AF. 1346 , 1347 , 1348 , 1349 , 1350 A recent meta-analysis of 16 RCTs of surgical ablation and concomitant operations evaluated predominantly mitral operations, but included both AVR and CABG operations. 1333 There were no significant differences in mortality, stroke, or pacemaker requirement between surgical ablation compared with no ablation; however, the surgical ablation groups demonstrated superior 1-year freedom from AF in AVR and AVR+CABG.…”

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

“…The literature also reports different ablative sources (e.g., radiofrequency and cryoablation) and different surgical techniques (e.g., epicardial versus endocardial ablation). Some studies have also noted that duration of AF and LA size are important predictors of ablation failure [177,179].…”

Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting

“…Of the 24 included studies, 12 of them were dedicated to reporting the surgical treatment of AF in patients undergoing CABG (16, 20, 22–33). Data about CABG patients were extracted from the subgroup analysis of the remaining 12 studies, which were principally reported concomitant cardiac surgery outcomes (34–46). The full Cox-Maze lesion set was used only in 4 (17%) studies.…”

“…Six studies were included to report the outcomes of pulmonary vein isolation (PVI) for the treatment of atrial fibrillation in this patient population. Subgroup analysis was used to extract data in 1 of 6 papers (46).…”