Benefit of ablation of first diagnosed paroxysmal atrial fibrillation during coronary artery bypass grafting: a pilot study†

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Abstract

OBJECTIVES

Whether patients with recent onset of paroxysmal atrial fibrillation (PAF) might benefit of epicardial atrial fibrillation (AF) ablation concomitant to coronary artery bypass graft (CABG) is not known. The aim of this prospective, randomized, single-centre pilot study is the comparison of patients with first diagnosed AF submitted to CABG and treated with and without epicardial pulmonary vein isolation (PVI).

METHODS

Patients with first diagnosed PAF and indication for CABG were enrolled in this prospective randomized pilot study. The primary endpoint was AF-free survival (AF burden <0.5%) between the two groups at 18-month follow-up. The secondary endpoints were the percentage of AF burden defined through continuous monitoring using an implantable loop recorder, thromboembolic events and procedural complications. All patients were implanted with a subcutaneous cardiac monitor to track the cardiac rhythm and measure the AF burden.

RESULTS

This study enrolled 35 patients (mean age 59 ± 7 years, 74% males), followed up for 18 months after CABG. The patients were randomly allocated to two groups, CABG alone (n = 17) and CABG with concomitant PVI (n = 18). At 18-month follow-up after surgery, 16 (89%) patients in the CABG + PVI group were AF-free (i.e. AF% < 0.5%) vs 8 (47%) in the CABG only group (log-rank test, P = 0.007). At the end of follow-up, the mean AF burden in the CABG and the CABG + PVI group was 7.8 ± 5.1 and 1.6 ± 1.8%, respectively (P < 0.001). Two (18.2%) of the 11 patients with AF recurrences were completely asymptomatic.

CONCLUSIONS

Patients with recent-onset AF submitted to CABG may benefit of concomitant ablation of the arrhythmia for preventing recurrences.

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