Early Stable Sinus Rhythm Associated With Greater Success 5 Years After Surgical Ablation.

BACKGROUND: An important challenge in surgical ablation for atrial fibrillation (AF) is the scarcity of publications on credible predictors of long-term success in procedures performed with ablation tools that produce consistently reliable transmural lesions. We examined factors associated with 1-year success and no atrial arrhythmia (AA) recurrence during 1 to 5 years after surgical ablation for AF.

METHODS: The study prospectively monitored 743 surgical ablation patients with complete rhythm follow-up at 12 months after the operation. No detected AA was defined as no known recurrence of AA, no cardioversions, and no catheter ablations at all available follow-up assessments.

RESULTS: Patients were a mean age of 64.7 years, and 32% were women. Patients with no detected AA during the first year after surgical ablation were more likely to maintain sinus rhythm without recurrence during 1 to 5 years (74% vs 28%, p < 0.001) and to be in sinus rhythm off medication at 5 years (80% vs 53%, p < 0.001). Mixed-model logistic regression revealed that lower risk for AA recurrence during 1 to 5 years was associated with no detected AA during the first 12 months (odds ratio [OR], 0.11; p < 0.001) and surgeon experience with 50 or more cases (OR, 0.63; p = 0.043), whereas older age (OR, 1.03; p < 0.001) and longer preoperative AF duration (OR, 1.04; p = 0.043) were associated with greater risk for AA recurrence.

CONCLUSIONS: Most patients with no detected AA throughout the first 12 months after surgical ablation continued to be recurrence free for 5 years. Younger age, shorter preoperative AF duration, and greater surgeon experience may be associated with more persistent surgical correction of AF.