Procedural Arrhythmia Termination During Beating-Heart, Stand-Alone Surgical Ablation and Long-Term Outcome in Patients with Persistent Atrial Fibrillation

Summary Objectives: Termination of atrial fibrillation (AF) during transcatheter ablation has been associated with improved outcomes in some studies. Our aim was to determine if termination of AF during beating-heart surgical ablation affects long-term results. Design and methods: This observational, retrospective study included 69 patients who underwent minimally invasive stand-alone surgical epicardial ablation for non-valvular, persistent AF using a bipolar ablation device. Patients with confirmed pulmonary vein isolation were included in the evaluation. Absence of arrhythmia was confirmed at 3, 6, and 12 months and annually thereafter with 24-h Holter monitoring. Results: Altogether, 39 (57%) patients were in AF at the beginning of surgical procedure. Among them, 21 (54%) recovered their sinus rhythm (SR) during the ablation: 7 (18%) had AF termination during left atrial ablation, 14 (36%) had AF termination during right atrial (RA) ablation. The remaining 18 (46%) patients required cardioversion to achieve SR. The mean follow-up was 55 ± 24 months. There were no significant differences in the patients’ preoperative and intraoperative data. The percentages of patients without AF termination during ablation who experienced freedom from AF and antiarrhythmic medications at 1, 2, 3, 4, and 5 years postoperatively were 78%, 63%, 50%, 33%, and 43%, respectively. The corresponding percentages in patients with AF termination were 83%, 74%, 67%, 71%, and 75%, respectively. Conclusions: There is a trend towards better long-term results if arrhythmia was terminated during surgical epicardial ablation on beating heart. Termination of AF during RA ablation (observed in 36% of patients), suggests that AF is a biatrial disease in patients with persistent AF.