COMPLEX ASSESSMENT OF OUTCOMES OF SURIGICAL TREATMENT OF PERSISTENT ATRIAL FIBRILLATION DURING AORTOCORONARY BYPASS GRAFTING SURGERY

To study effectiveness of radiofrequency ablation (RFA) of atrial fibrillation (AF) in patients with coronary artery disease (CAD) during the aortocoronary bypass grafting surgery (ACBG), to assess freedom from arrhythmia in the late post-operation period, pro-arrhythmic effects, and quality of life of patients after the surgery, 95 patients (74 men; 78%), aged 62.8±8.8 years were examined and surgically treated. Group I included 31 patients, in whom radiofrequency ostial pulmonary vein isolation (ROPVI) was performed. The radiofrequency procedure Cox-Maze was performed in 30 patients of Group II. In 34 patients of Group III, only the ABCG surgery was performed. According to the echocardiography data, ejection fraction lower than 35% was found in 8 patients, moderate mitral insufficiency, in 22 patients, and the left ventricular aneurysm, in 9 subjects. ROPVI included application of ablation lines on common collectors of pulmonary vein ostia. The radiofrequency procedure Cox-Maze included the ostial pulmonary vein isolation, resection of the left auricle, as well as application of ablation lines from the resected left auricle towards the left upper and lower pulmonary veins, as well as the fibrous ring of the mitral valve, and on the left atrial roof. For persistent long-term ECG monitoring in the late post-operation period, implantable devices Reveal XT were used. The ACBG surgery in combination with different types of AF ablation took place in the study subjects without technical issues. During the application of ablative lines, no issues related to the branch positioning were noted. All patients after AF ablation received antiarrhythmic and anticoagulant therapy in early post-operation period to prevent iatrogenic arrhythmias. No significant difference was observed in the duration of stay in ICU in all three groups; no differences between both study and control group in the clinical course of the post-operation period and incidence of complications developed in the early post-operation period were revealed, as well. At the discharge from hospital, the sinus rhythm was documented in all patients from Group I and control group excluding one patient from both above groups apiece who had the pacemaker rhythm after the planned pacemaker implantations occurred during the surgery. In the late post-operation period, the sinus rhythm was detected in 26 patients of 30 (86.7%). In Group II, 28 patients of 29 (96.5%) had the sinus rhythm one year after the operation. In the control group after one year of follow-up, only 18 patients of 34 had the sinus rhythm, i.e. the freedom from arrhythmia was 53%. Thus, RFA of persistent AF during the ACBG procedure is a highly effective and safe method of treatment of AF. Radiofrequency isolation of pulmonary vein ostia during the ACBG surgery permits one to restore the sinus rhythm in 100% of patients and radiofrequency procedure Cox-Maze, in 96.7% of patients. The radiofrequency procedure Cox-Maze is associated with a less pro-arrhythmic effect than the radiofrequency isolation of pulmonary vein ostia. The effective AF elimination during the ACBG surgery improves the quality of life of the patients according to all scales of the SF 36 questionnaire. Insertable cardiac monitors are highly effective in detection of AF paroxysms and permit one to correct or discontinue antiarrhythmic and/or anticoagulant therapy in proper time. Radiofrequency isolation of pulmonary vein ostia during the ACBG surgery maintains the sinus rhythm in the late post-operation period in 80% of patients with persistent AF, the radiofrequency procedure Cox- Maze, in 86.2% of patients, and the ACBG surgery alone, in 44.1% of subjects.

coronary artery disease, aorto-coronary bypass grafting, persistent atrial fibrillation, radiofrequency ablation, isolation of pulmonary vein ostia, Cox-Maze procedure

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