Surgery For Atrial Fibrillation In Mitral Patients With And Without Additional Procedures. Results At 5 Years From An International Registry
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Objectives - Atrial fibrillation is a comorbid situation in mitral patients leading to poor prognosis after surgery. There are conflicting reports concerning the added value of concomitant AF surgery in mitral patients, thus making difficult the choice of the ideal surgical approach. An international registry of atrial fibrillation surgery patients, operated in 10 centers in America and Europe was created in an attempt to provide a better insight at these clinical controversies.
Methods - 1476 mitral surgery pts (mean age 63±11 years, 898 female) were enrolled in the registry. Additional procedures were tricuspid surgery in 436 pts, aortic surgery in 234, and CABG in 86 pts. Hospital risks are based on data from the whole group and AF surgery results were based on data from pts with follow-up >1 year (pts with incomplete data were censored). 768 pts had over 1 year follow-up. Out of these 734 had AF treatment using ablation energies and 34 cut and sew technique. Left sided approaches were performed in 481 pts, the remaining underwent biatrial approaches.
Their average follow-up was 2.5 ±1.7 years (range 1-8.5), P75 = 3.4 years. Binary logistic regression analysis was used to assess follow-up results. In order to assess the resulting rhythm pts were accordingly divided into 3 groups: stable SR (sSR), stable AF (sAF) and intermittent rhythms (IR).
Results - Operative mortality was 3.9 % (57/1476). At 1 year 71% of the patients were in sSR, 23 % had sAF and 6 % had IR (Graph1). Over the next 5 years there was an attrition rate of 2.6 % / year for recurrence of AF. After adjustment for age, gender, type of preop AF, surgical technique and additional surgery, the best positive predictor for stable SR at any point in time was the size of the left atrium. The ideal cuttoff point was 58 mm measured by 2D echo (OR = 2.9 (1.82-4.62) p < 0.001).
Conclusions - Surgery for concomitant AF is safe in mitral patients. Its expected success rate (defined as stable sinus rhythm) at 1 year is 71%, with a small attrition rate thereafter. The best predictor of success is left atrium size. In mitral patients the addition of concomitant procedures (valve, CABG) does not affect the success rate of AF surgery. 
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