Objective: Surgical ablation of atrial fibrillation (AF) has become a well-established procedure. Its' positive early and mid post-operative effects seem to differ significantly in paroxysmal, persistent and long-standing persistent cases of AF.
Methods: Between February 2004 and March 2013 we performed surgical AF ablation bipolar radiofrequency ablator and cryoprobe as part of another cardiac procedure in 325 patients. We divided patients into 3 groups according to the type of AF. 109 (33%) had long-standing persistent, 161(50%) persistent and 55 (17%) patients had paroxysmal atrial fibrillation. Patients were 63±11 years of age. Age and functional class were similar in all groups. Patients with long-standing persistent atrial fibrillation had larger left atria (p=0.01) and longer history of atrial fibrillation. Ablation procedures were similar in all groups of patients.
Results: Mean follow-up was 41 months (range 26-70 months), and was performed by electro physiologists and surgeons. 6 months following the ablation, 95%, 93%, and 72%, of patients were in sinus rhythm in paroxysmal, persistent and long-standing persistent groups respectively(p=0.02). 1 year after ablation sinus rhythm was found in 97%, 88%, and 74% of patients in paroxysmal, persistent and long-standing persistent groups respectively (p=0.006). At 3 years follow up 86%, 83% and 73% of patients were in sinus rhythm in these 3 groups (p=0.1).
Conclusions: The surgical ablation seems to be significantly more effective in paroxysmal and persistent AF cases in comparison to long-standing persistent atrial fibrillation. On the other hand results of surgical ablation of long-standing AF remain stable in the late follow up. The ablation efficacy in paroxysmal and persistent AF shows some attrition during 3 year follow up.
