A left atrial versus a biatrial lesion set for persistent atrial fibrillation ablation during open heart surgery.

Autor:	Bogachev-Prokophiev AV; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Afanasyev AV; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Pivkin AN; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Ovcharov MA; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Zheleznev SI; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Sharifulin RM; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation., Karaskov AM; Department of Heart Valves Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2018 Oct 01; Vol. 54 (4), pp. 738-744.
DOI:	10.1093/ejcts/ezy126
Abstrakt:	Objectives: To compare the outcomes of left atrial ablation and biatrial (BA) ablation in patients with persistent and long-standing persistent atrial fibrillation undergoing open heart surgery. Methods: Between January 2007 and December 2016, 588 consecutive patients with either persistent (20.9%) or long-standing persistent atrial fibrillation (79.1%) were enrolled in this study. To reduce between-group differences, propensity score-matched groups (156 patients/group) were obtained, with similar preoperative and perioperative characteristics. Results: The propensity score-matched left atrial and BA groups did not differ regarding 30-day mortality (1.9% vs 0.6%; P = 0.617), 5-year overall survival (93.5 ± 2.2% vs 92.8 ± 2.9%, P = 0.998) or survival free from thromboembolic events (97.1 ± 2.8% vs 96.2 ± 2.7%, P = 0.309). The BA lesion set was more beneficial in terms of freedom from atrial arrhythmia recurrence (85.3 ± 4.5% vs 91.9 ± 3.1%, P = 0.049; hazard ratio 3.26; 95% confidence interval 1.33-7.99), but it was associated with higher pacemaker implantation rate (3.8% vs 17.3%; P < 0.001) due to sinus node dysfunction. There was no significant between-group difference regarding the incidence of atrioventricular conduction disturbances (3.2% vs 7.0%, respectively; P = 0.211). Conclusions: The 2 lesion sets (left atrial and BA) are associated with similar 30-day mortality, survival rates, incidences of embolic events and atrioventricular conduction disturbances. In patients with persistent atrial fibrillation, concomitant surgical ablation with BA lesion set provided better freedom from atrial arrhythmia recurrence, but BA ablation was associated with a higher incidence of sinus node dysfunction and a higher rate of pacemaker implantation.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu