Abstract

Objectives

Surgical ablation is an established treatment for patients with atrial fibrillation undergoing cardiac surgery. This study aimed to compare postoperative rhythm outcomes and pacemaker implantation rates after biatrial ablation or pulmonary vein isolation (PVI) concomitantly with other cardiac surgery. Design: In a retrospective study, we included patients who underwent biatrial ablation or PVI. Postoperative rhythm status was assessed by Holter monitoring. All data on outcomes and patient characteristics were collected retrospectively. Results: In total 109 patients had a biatrial procedure whereas 337 had PVI performed. In patients with persistent/long-standing persistent atrial fibrillation, freedom from atrial fibrillation was more common after biatrial ablation than after PVI (63% and 45%, respectively; p = .039). Postoperative permanent pacemaker implantation was more common after biatrial ablation (12% and 6%, respectively; p = .039), compared to PVI. Age < 65 years (OR:2.0, 95% CI:1.1–3.6) was a predictor of freedom from atrial fibrillation in the biatrial group, whereas absence of left atrial dilatation (OR:1.8, 95% CI:1.1–3.2) and HAS-BLED score < 2 (OR:1.9, 95% CI:1.0–3.8) were significant predictors of freedom from atrial fibrillation in the PVI group. Conclusions: In patients with persistent/long-standing persistent atrial fibrillation, biatrial ablation is more effective than PVI in terms of obtaining freedom from postoperative atrial fibrillation. Although our groups were heterogenic in terms of concomitant surgery, our study also indicates that the risk of needing a permanent pacemaker is higher after biatrial ablation, compared to PVI. Therefore, our study highlights that the decision between biatrial ablation or PVI should be performed on an individual basis.

中文翻译：

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接受心脏手术的心房颤动患者的双心房消融与肺静脉隔离：一项回顾性研究

摘要

目标

对于接受心脏手术的心房颤动患者，手术消融是一种既定的治疗方法。本研究旨在比较双心房消融或肺静脉隔离 (PVI) 与其他心脏手术后的术后节律结果和起搏器植入率。设计：在一项回顾性研究中，我们纳入了接受双心房消融或 PVI 的患者。通过动态心电图监测评估术后节律状态。回顾性收集有关结果和患者特征的所有数据。结果：共有 109 名患者进行了双心房手术，而 337 名患者进行了 PVI。在患有持续性/长期持续性心房颤动的患者中，双心房消融后无心房颤动比 PVI 后更常见（分别为 63% 和 45%；p  = .039）。 与 PVI 相比，双心房消融术后永久性起搏器植入更为常见（分别为 12% 和 6%；p = .039）。年龄 < 65 岁 (OR:2.0, 95% CI:1.1–3.6) 是双心房组无心房颤动的预测因子，而左心房无扩张 (OR:1.8, 95% CI:1.1–3.2) 和HAS-BLED 评分 < 2 (OR:1.9, 95% CI:1.0–3.8) 是 PVI 组无房颤的重要预测指标。结论：在持续性/长期持续性房颤患者中，双心房消融比 PVI 更有效地避免术后房颤。尽管我们的组在伴随手术方面存在异质性，但我们的研究还表明，与 PVI 相比，双心房消融后需要永久性起搏器的风险更高。因此，我们的研究强调双心房消融或 PVI 之间的决定应根据个人情况进行。