Surgical treatment of concomitant atrial fibrillation during cardiac surgery: a single-center experience
Abstract
Objective: to evaluate the immediate outcomes of surgical treatment for concomitant atrial fibrillation (AF) during structural heart disease repair using various radiofrequency ablation techniques.
Materials and Methods: the study included 149 patients with AF who underwent concomitant valve and/or coronary surgery. Patients were divided into four groups according to intervention type: coronary artery bypass grafting (CABG) with radiofrequency ablation (RFA), minimally invasive thoracoscopic ablation with LAD grafting (MIDCAB), mitral valve surgery with RFA, and aortic valve surgery with RFA. Both Maze IV and Dallas lesion sets were utilized. Outcomes assessed included sinus rhythm restoration, permanent pacemaker implantation, complications, and early postoperative mortality. Multivariate statistical analysis was performed.
Results: median time of operation ranged from 195 to 230 minutes (p = 0.001). Statistically significant differences were observed in cardiopulmonary bypass and aortic cross-clamp times (p = 0.001). The MIDCAB group showed the shortest time of mechanical ventilation and ICU stay. Overall mortality was 2.0% with no intergroup differences. The rate of uncomplicated postoperative recovery reached 78.6% in the MIDCAB group. Sinus rhythm at discharge was restored in 91.5% of CABG group, 100% of MIDCAB group, 71.0% of the mitral group, and 68.4% of the aortic group. The Maze IV procedure showed significant association with sinus rhythm restoration (OR=5.0; p=0.03) without increased permanent pace-maker implantation rates.
Conclusion: concomitant surgical AF ablation during structural heart disease correction demonstrates high sinus rhythm restoration efficacy. The Maze IV procedure provides superior rhythm control compared to the Dallas lesion set. Minimally invasive interventions with thoracoscopic ablation yield the most favorable early results.
About the Authors
D. O. Bystrov
EE Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Dmitriy O. Bystrov - MD, PhD, Cardiovascular Surgeon
1, Suvorova street, Arkhangelsk, 163001
A. N. Shonbin
EE Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Alexey N. Shonbin - MD, PhD, Cardiovascular Surgeon, Head of Departmen
1, Suvorova street, Arkhangelsk, 163001
B. O. Afonin
EE Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Boris O. Afonin - MD, Cardiovascular Surgeon
1, Suvorova street, Arkhangelsk, 163001
R. O. Sorokin
EE Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Roman O. Sorokin - Cardiovascular Surgeon
1, Suvorova street, Arkhangelsk, 163001
Yu. A. Efimova
EE Volosevich First City Clinical Hospital
Russian Federation
Russian Federation
Yulia A. Efimova - MD, Cardiologist, Clinical Physiologist
1, Suvorova street, Arkhangelsk, 163001
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Review
For citations:
Bystrov D.O., Shonbin A.N., Afonin B.O., Sorokin R.O., Efimova Yu.A. Surgical treatment of concomitant atrial fibrillation during cardiac surgery: a single-center experience. Minimally Invasive Cardiovascular Surgery. 2025;1(1):11-20. (In Russ.)
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