Improved AF outcomes from extensive lesion sets

‘Extensive’ surgical ablation (combining left and right atrial lesion sets) lead to significantly improved outcomes for atrial fibrillation (AF) patients when compared to more limited procedures, according to a study(1) published recently in the Journal of the American College of Cardiology.

The objective of this study was to evaluate the effects of different lesion sets of ablation in patients undergoing mitral surgery plus maze. A total of 141 AF patients were prospectively followed up, having undergone two different lesion sets: 32 underwent a radiofrequency left atrial lesion set of maze (“limited”), and 109 had combined left and right atrial lesion sets of maze ± ganglionic plexi isolation (“extensive”).

The prevalence of AF over time was lower in the “extensive” arm (adjusted relative risk [RR]: 0.10; 95% confidence interval [CI]: 0.03 to 0.31; p < 0.001), with significantly lower prevalence at discharge, three months, and 18 months. The prevalence of patients in New York Heart Association (NYHA) functional class II/III over time was lower in the “extensive” arm (adjusted RR: 0.11; 95% CI: 0.03 to 0.34; p < 0.001), with significant differences at any assessment (except the third month).

The differences in E/A recovery and use of antiarrhythmic drugs were less marked, with an RR of 1.55 (95% CI: 0.99 to 2.42; p = 0.05) and RR of 0.76 (95% CI: 0.54 to 1.06; p = 0.11), respectively, with a significantly lower prevalence of antiarrhythmic drugs in the “extensive” ablation arm at 12, 18, and 24 months. Rates of hospitalization for heart failure, overall hospitalization, and the combined event death/hospitalization were lower in the “extensive” arm (p = 0.11, p = 0.003, and p = 0.002, respectively).

References

Onorati F, Mariscalco G, Rubino AS et al. Impact of Lesion Sets on Mid-Term Results of Surgical Ablation Procedure for Atrial Fibrillation. JACC 2011;57:931– 40.