Surgical perspectives in the management of atrial fibrillation

Table 7 Summary of results from studies included looking at radiofrequency ablation

Procedure	Ref.	Sample size	Mean follow-up period	Outcome	Important findings
Concomitant RFA	Johansson et al[32]	39 patients undergoing CABG	32 ± 11 mo	62% freedom from AF in ablation group compared to 33% in non-ablation group	Sinus rhythm at 3 mo was highly predictive of long-term sinus rhythm
Concomitant RFA	Khargi et al[33]	128 patients in permanent AF (Group 1: mitral valve surgery, group 2: aortic valve surgery or CABG)	3, 6 and 12 mo ECG and sinus rhythm confirmed with 24hrs ECG	71% post-operative sinus rhythm in group 1 vs 79% in group 2	Concomitant RFA in mitral valve surgery and aortic valve surgery or CABG is equally effective
Concomitant RFA	Beukema et al[34]	258 patients with permanent AF	43.7 ± 25.9 mo	Sustained sinus rhythm in 69% of patients at 1 yr, 56% at 3 yr, 52% at 5 yr and 57% at the latest follow up	RF modified maze procedure abolished AF in the majority of patients
Concomitant RFA	Chiappini et al[35]	Review of 6 studies - 451 patients in total	13.8 ± 1.9 mo	97.1% overall survival rate, 76.3% ± 5.1% overall freedom from AF	RFA is a safe and efficient procedure to cure AF in patients undergoing concomitant heart surgery
Concomitant RFA	Von Opell et al[36]	49 patients with AF of more than 6 mo duration	At discharge, 3 and 12 mo post procedure	Return to sinus rhythm 29% 57% and 75% (at discharge, 3 mo and 12 mo post-procedure) in the cardioblate group vs 20%, 43% and 29% respectively in the control group	Concomitant RFA resulted in 75% conversion rate to sinus rhythm compared to the control group (39%)
Concomitant RFA	Budera et al[38]	Multicentre RCT involving 224 patients with AF undergoing cardiac surgery with ( n = 117) or without ablation (n = 107)	30 d	At 1 yr follow up, 60.2% of patients were in sinus rhythm in the ablation group compared to 35.5% in the control group. 1 yr mortality was 16.2% and 17.4% respectively	Concomitant ablation increases postoperative sinus rhythm with no effect on peri-operative complications
Concomitant RFA	Blomström-Lundqvist et al[40]	Double-blind randomized study of 69 patients undergoing mitral valve surgery with or without epicardial left atrial cryoablation	6 and 12 mo	At 6 mo follow-up, 73.3% of patients in the cryoablation group regained sinus rhythm vs 45.7% of patients with mitral valve surgery alone (P = 0.024). At 12 mo follow-up, the results were 73.3% vs 42.9% respectively (P = 0.013)	Concomitant left atrial epicardial cardioablation is significantly better in regaining sinus rhythm in patients with permanent AF compared to mitral valve surgery alone
Concomitant RFA	Chevalier et al[61]	Prospective, multicentre, double-blinded RCT involving 43 patients with mitral valve disease and permanent AF	12 mo	At 12 mo, sinus rhythm was maintained without any arrhythmia recurrences in 57% of patients in the RFA group vs 4% in the control group (undergoing mitral valve surgery only)	Left atrial RFA is an effective procedure in patients suffering with long-term AF and co-existing valvular disease
Concomitant RFA	Veasey et al[62]	100 patients in paroxysmal or persistent AF undergoing cardiac surgery were enrolled	6 mo	75% freedom of AF at 6 mo follow-up post concomitant RFA. The AF burden decreased from 56.2% post-operatively to 27.5% at 6 mo post-operatively. 13% of patients had asymptomatic AF episodes identified via continuous monitoring	Concomitant RFA successfully reduces AF burden but based on these results, the importance of post-operative antiarrhythmic medication and anticoagulation should be evaluated

RFA: Radiofrequency ablation; AF: Atrial fibrillation; ECG: Electrocardiogram; CABG: Coronary artery bypass grafting.