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Surgical ablation of atrial fibrillation concomitant with valvular surgery: is it worthed?
Session:
Best Posters
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.9 Cardiovascular Surgery – Arrhythmias
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida G. Figueiredo; Rui Cerejo; Sofia B. Paula; Carolina Rodrigues; Manuela Silva; Guilherme Portugal; Pedro Cunha; Hélder Santos; Rui Rodrigues; Mário Oliveira; Pedro Coelho
Abstract
<p><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif"">Atrial fibrillation (AF) is associated with an increased risk of stroke, heart failure and reduced survival, and is extremely prevalent in patients (P) with valvular heart disease. According to previous studies, the addition of AF ablation during surgical valvular procedures reduces the postoperative AF recurrence rate and improves survival. Purpose: We aim to compare long-term efficacy of surgical AF ablation between P with AF without structural heart disease and those with AF and concomitant valvular disease requiring surgical intervention. Methods: Single-center retrospective study engaging P with AF undergoing surgical ablation. P were divided into two groups: Group A – AF and no concomitant heart disease; Group B – AF and heart valve disease requiring surgical intervention. Results: A total of 47 P were analyzed, 19 in group A (40.4%) and 28 in group B (59.6%). In Group A, the median age was 57.0 (52.0 - 68.0) years, with 47.4% female, while in Group B the median age was 64.0 (20.3 – 69.8) years and 60.7% were female (p<0,05). Regarding the type of AF, Group A had 63.2% with paroxysmal AF (PAF) and Group B 39.3% (p=0.1). All P in group A had been submitted to prior catheter ablation, in comparison to only 7.1% of P in Group B (p<0.001). In Group B, 46.4% were submitted to mitral replacement, 21.4% to aortic replacement, 10.7% to tricuspid intervention and 21.4% to combined valvular surgery. Mean left ventricular ejection fraction (LVEF) by echocardiogram was 54.1 ± 12.4% and 55.2 ± 7.0% in groups B and A, respectively (p=0.761). Group B had a more dilated left atrium (64.0 (51.5 – 73.5) ml/m<sup>2</sup> versus 37.0 (25.0 – 45.0) ml/m<sup>2</sup>, p<0.001), and higher pulmonary systolic pressure (38.5 (35.0 – 47.3) mmHg vs. 31.0 (26.5 – 34.0) mmHg, p<0.001). All P in Group A underwent surgical ablation with bipolar radiofrequency, while only 17.9% of Group B were submitted to this type of ablation (p<0.001). During hospitalization, 84.2% of Group A and 60.7% in Group B remained in sinus rhythm (SR), p=0.084. All Group A P were discharged in SR vs. 71.4% of the P in group B (p=0.011). Median follow-up time was 36.0 (22.0 – 50.0) vs. 26.0 (12.3 – 48.0) months in in Group A and Group B, respectively (p=0.374). During follow-up, there were no statistically significant difference regarding maintenance of SR: 68.4% in Group A vs. 67.9% in Group B (p=0.972) at 1 month, 89.5% vs. 67.9% (p=0.071) at 6 months, and 84.2% vs. 67.9% (p=0.182) at 1 year and 78.9% vs. 78.6% (p=0.831) in long-term follow-up. Recurrence rate of AF was 26.3% in Group A and 39.3% in Group B, p=0.357. Kaplan Meier test showed no statistically significant differences in terms of AF recurrence between both groups (Figure 1). Conclusion: Despite the presence of structural cardiac disease and worst cardiac performance at the moment of the surgery, AF surgical ablation concomitant with correction of the valvular disease contributes to increase the rate of freedom from AF in the long-term follow-up.</span></span></p>
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