Aim. To identify the predictors of atrial fibrillation (AF) recurrence after simultaneous Maze V procedure in combination with coronary artery bypass grafting.Methods. Medical records of 102 patients with coronary artery disease and concomitant AF were retrospectively reviewed. All patients underwent coronary artery bypass grafting and the combined Maze V procedure. The patients were divided into 2 groups: 51 patients with paroxysmal AF (group I), and 51 patients with non-paroxysmal AF (group II). In group I, 6 cases of AF recurrence were detected (subgroup IA), while 45 patients (subgroup IB) maintained sinus rhythm for the entire follow-up period. Accordingly, in group II, the return of AF was noted in 9 patients (subgroup IIA), sinus rhythm - in 42 patients (subgroup IIB). The follow-up period was 36 months. Clinical and echocardiographic parameters were studied as predictors of AF recurrence.Results. A significant predictor in patients with paroxysmal AF was a recurrence of AF at the hospital stage (odd ratio (OR) 10,25; 95% confidence interval (CI) 1,53-68,20; р=0.032). The duration of the AF history was the main predictor in patients with non-paroxysmal AF (OR 8,8; 95% CI 1,01-76,1; р=0.04). ROC analysis revealed a significant effect on the AF recurrence of left atrium (LA) dimension >48.5 mm, LA volume index >44.4 ml/m2 for patients with paroxysmal AF, and left ventriclular end-diastolic volume > 150 ml for patients with non-paroxysmal AFConclusion. A recurrence of AF at the hospital stage, LA dimension, LA volume index were significant predictors of AF recurrence after coronary artery bypass grafting + Maze V procedure in patients with paroxysmal AF. А long AF history and left ventriclular end-diastolic volume played the role of predictors for patients with non-paroxysmal AF.

Highlights. Maze V significantly reduces the recurrence of AF compared to bipolar RFA for PVI in the short and mid-term period. Aim. To assess the effectiveness and safety of pulmonary vein isolation (PVI) in comparison with Maze V for treating paroxysmal atrial fibrillation (AF) concomitant to coronary artery bypass grafting (CABG). Methods. Medical records of 139 patients with coronary artery disease and concomitant paroxysmal AF were retrospectively analyzed. All patients were divided into two groups: Group 1 patients (n = 71) underwent CABG + bipolar radiofrequency ablation for PVI, and Group 2 patients (n = 68) underwent Maze V + CABG. Propensity score-matched (PSM) analysis with a 1:1 nearest-neighbor matching was done. 30 patients were selected from each group. The exclusion criteria were as follows: emergent CABG, concomitant valvular heart disease, non-paroxysmal AF, decompensation of chronic diseases, and cancer. On-pump CABG was performed at normothermia with warm blood hyperkalemia cardioplegia. RFA for PVI and Maze V were performed before CABG under parallel perfusion without aortic cross-clamping. The primary and secondary endpoints included recurrent AF/atrial flutter, sinus rhythm at discharge and in the long-term period, permanent pacemaker implantation, major cardiovascular and cerebrovascular events. Results. After the PSM analysis, the CABG+Maze V group and CABG+RFA for PVI differed significantly in the duration of surgery (330 [310; 375] vs. 255 [225; 270] min, p = 0.0001), cardiopulmonary bypass time (131 [113; 144] min vs. 89 [74; 98] min, p = 0.0001), duration of AF treatment (53 [44; 59] min vs. 10 [9; 12] min, p = 0.0001). The structure and rate of complications in both groups were comparable. There were no in-patient deaths. Recurrent AF/atrial flutter significantly reduced in the CABG+Maze V group compared to the CABG+RFA for PVI group (13.3% vs. 33.3%, respectively; p = 0.044). Sinus rhythm was restored in all cases. The rate of transient sinus node dysfunction (no more than 5 days) was 6.7% in the Group 1 and 16.6% in the Group 2. The difference did not reach statistical significance (p = 0.128). The 12-months cumulative freedom from AF/atrial flutter without antiarrhythmic drug therapy was significantly higher in the CABG+Maze V group compared to the CABG+RFA for PVI group (97% vs. 83.5%, respectively; p = 0.020). The freedom from MACE in both groups was 96.7%. Conclusion. Maze V for treating concomitant paroxysmal AF prolonged the duration of cardiopulmonary bypass and the surgery itself, but did not affect the postoperative period, indicating its safety and effectiveness. Maze V procedure concomitant to CABG significantly reduced the recurrence of AF compared to RFA for PVI both in the short- and mid-term period. Thus, it is reasonable to perform Maze V+CABG in patients with paroxysmal AF and a high risk of disease progression.

Цель – оценить эффективность симультанного хирургического лечения фибрилляции предсердий (ФП) при коррекции митрально-аортальных пороков сердца.

Aim. To evaluate the in-hospital results of the epicardial bipolar radiofrequency ablation of the pulmonary vein in the prevention of new-onset postoperative atrial fibrillation (POAF) in coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) surgery in a pilot randomised multi-centre controlled Pulmonary Vein Ablation (PULVAB).Methods. The pilot study was conducted for the organisation of a multi-centre randomised PULVAB trial. We enrolled 63 CAD patients without a history of AF. The inclusion criterion was CAD demanding CABG; the exclusion criteria were as follows: AF history, antiarrhythmic therapy in anamnesis, significant heart valve disease, severe renal failure and decompensating diabetes mellitus. The patients were randomised into 2 groups. Group I comprised 34 patients who underwent CABG alone, and Group II had 29 patients who underwent CABG combined with radiofrequency ablation (RFA) as the initial tool for POAF prevention. All the procedures were performed by a single surgical team using standardised anaesthetic and perfusion support.Results. There was no in-hospital mortality in either group. There were differences in the duration of the intervention, cardiopulmonary bypass time and the aorta clamping time between groups (p > 0.05). A higher incidence of POAF was observed (11 %–32.4 %) in the isolated CABG group than in the CABG combined with PULVAB group (6 %–20.7 %), although the difference was not significant (p = 0.29). In most cases (91 %), AF occurred on the second to third postoperative day, irrespective of the observation group.Conclusion. The combination of CABG and RFA does not complicate the operation and does not increase the duration of the surgery or time of cardiopulmonary bypass. There were no significant differences in the postoperative course or the incidence and structure of complications between the groups. This may indicate the safety of our method. The positive tendency of POAF-cases decrease after preventive epicardial RFA observed in the present study allows us to continue the PULVAB study to gain more statistically significant results.Clin.Trials.gov Identifier: NCT03857711 Received 20 February 2020. Revised 29 June 2020. Accepted 2 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.Sh. Revishvili, V.A. PopovData collection and analysis: M.M. Anishchenko, E.S. Malyshenko, N.V. PopovaStatistical analysis: M.M. AnishchenkoDrafting the article: G.P. Plotnikov, M.M. AnishchenkoCritical revision of the article: A.Sh. Revishvili, V.A. PopovFinal approval of the version to be published: A.Sh. Revishvili, V.A. Popov, E.S. Malyshenko, G.P. Plotnikov, M.M. Anishchenko, N.V. Popova

Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.