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KMID : 1164620190520020061
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Korean Journal of Thoracic and Cardiovascular Surgery
2019 Volume.52 No. 2 p.61 ~ p.69
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Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement
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Pyo Won-Kyung
Park Sung-Jung
Kim Wan-Kee
Kim Ho-Jin
Kim Joon-Bum
Jung Sung-Ho
Joo Suk-Jung
Chung Cheol-Hyun
Lee Jae-Won
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Abstract
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Background: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement.
Methods: From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes.
Results: During 49.1 months of follow-up (interquartile range, 22.5?96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02?1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22?7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00?1.05; p=0.045) were significantly associated with AF recurrence.
Conclusion: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.
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KEYWORD
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Arrhythmia surgery, Anticoagulants, Bioprosthesis, Atrial fibrillation, Surgical ablation
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