Objectives Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study.

Methods Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling.

Results Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: −6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (−7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF.

Conclusions Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.

目的 尽管伴随手术消融甚至可以帮助永久性心房颤动 (AF) 患者摆脱心房颤动 (FREEAF)，但一些心脏外科医生不愿进行伴随消融以避免围手术期风险升级。在这里，我们调查了一项所有参与者研究中伴随手术消融治疗成功的结果和预测因素。

方法 先前接受过永久性房颤 (FAP, n  = 41) 或阵发性房颤 (parAF, n  = 24) 的未接受过消融治疗的患者在两个外科部门接受了伴随的心外膜双极射频消融术和植入式环路记录仪 (ILR)。24 个月的随访检查包括心电图、ILR 读数、24 小时动态心电图监测、超声心动图和血液采样。

结果 86% 的 parAF 和 70% 的 FAP 患者达到 FREEAF（第 24 个月）。死亡率很低（parAF/FAP：5.3 ± 0.2%/4.1 ± 0.3%；p  < 0.05；EuroScoreII；6.1 ± 0.7%/6.4 ± 0.4%，p  = ns）并且没有发生中风。FREEAF 诱导心房逆重构（左心房 [LA] 直径：−6.7 ± 2.2 mm）和改善心功能（左心室射血分数 [LVEF]：+7.3 ± 2.8%），而 AF 导致心房进一步扩张（+8.0 ± 2.8%） 1.0 毫米，p  < 0.05）和 LVEF 降低（−7.0 ± 1.3%，p < 0.05)。较高的 LV（优势比 [OR]：1.164）和 LA 直径（OR：1.218）、年龄（OR：1.180）和体重指数（BMI）（OR：1.503）增加了 AF 复发的危险因素。保持窦性心律 (SR) 的患者 BMI 下降，而 AF 复发与稳定超重有关。进一步老化不会降低 FREEAF。

结论 即使在 FAP 患者中，通过伴随手术消融也可以实现长期 SR。因此，应定期提供。肥胖会影响治疗的长期成功，但也可能提供可寻址的治疗目标以达到更高的 FREEAF 率。