Ablation surgery failure after combined permanent atrial fibrillation ablation and mitral valve surgery

Objective: The aim of this study was to evaluate the early and late results of a permanent atrial fibrillation (pAF) ablation concept carried out concomitantly with mitral valve (MV) surgery and to identify risk factors for ablation surgery failure. Methods: Between February 2001 and April 2006,109 patients with pAF over a median time of 48 months (Perc25/75; range 6-396 months) underwent monopolar endocardial radiofrequency ablation procedures concomitantly with MV surgery. All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 +/- 1 months) and late after surgery (36 +/- 19 months). For data assessment an explorative data analysis including univariate and multivariate binary logistic regression was performed. Results: Early and late survival was 95% and 91%, respectively; at follow-up stable SR was documented in 76% (74%) of patients. NYHA class improved significantly after surgery (p = 0.009), particularly when stable SR was achieved (p = 0.042). Among these MV patients left atrial (LA) enlargement and pAF of long-time duration prior to surgery were detected as risk factors for postoperative recurrence and persistence of atrial fibrillation (p = 0.026 and p = 0.002); furthermore, advanced age and significant tricuspidal regurgitation at the time of surgery were also relevant. The best prediction (95% of patients) for SR, as demonstrated in a multivariate model, was based on the factors LA size and pAF duration (p = 0.052 and 0.005). Conclusion: Particularly the preoperative LA size and pAF duration seem to be useful parameters to evaluate the success rate of ablation performed concomitantly with MV surgery. It could be demonstrated that an established SR remains stable over time.