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Ann Thorac Surg 2006;81:1332-1337
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Combined Off-Pump Coronary Artery Bypass Grafting Surgery and Ablative Therapy for Atrial Fibrillation: Early and Mid-Term Results

Belhhan Akpinar, MD _^* , Ilhan Sanisoglu, MD, Mustafa Guden, MD, Ertan Sagbas, MD, Bars Caynak, MD, Zehra Bayramoglu, MD

Department of Cardiac Surgery, Florence Nightingale Hospital, Istanbul, Turkey

Accepted for publication September 30, 2005.

^_* Address correspondence to Dr Akpinar, Department of Cardiac Surgery, Florence Nightingale Hospital, Abidei Hurriyet Cad. No. 290 Sisli, Istanbul, PB80220, Turkey (Email: belhanakpinar{at}gmail.com).

BACKGROUND: The aim of this study was to evaluate the feasibility of off-pump coronary artery bypass grafting combined with radiofrequency ablation and to compare outcomes between patients with permanent and paroxysmal atrial fibrillation (AF) in terms of restoring sinus rhythm.

METHODS: Thirty-three patients underwent the combined procedure. Mean age was 62.34 ± 8.20 years; there were 12 female and 21 male patients. Twenty-one patients were diagnosed as permanent AF (group A) and 12 had paroxysmal AF (group B). After the off-pump revascularization patients underwent pulmonary vein ablation. Rhythm was evaluated at discharge and at 6 and 12 months' follow-up. Patients in stable sinus rhythm underwent transthoracic echocardiographic examination to evaluate atrial contractility at 6 and 12 months.

RESULTS: There was no operative mortality or major complications. The mean ablation time was 11 ± 3.4 minutes, including multiple applications. At the end of the procedure 84.5% of patients were free of AF. Sinus rhythm was established in 56% (group A, 52%; group B, 58.3%), 70.5% (group A, 58%; group B, 83.3%), and 71% (group A, 59%; group B, 83.3%) of patients at discharge and at 6 and 12 months, respectively (p = 0.249). Biatrial contractility was detected in 71% of group A and 76% of group B patients at 6 months' follow-up. More patients in group A returned to AF during follow-up when compared with group B (p = 0.016). Female sex (odds ratio, 2.1), chronic lung disease (odds ratio, 1.40), left ventricular disfunction (p = 0.016), and hypertension (odds ratio, 2.57) emerged as risk factors for AF recurrence after ablation.

CONCLUSIONS: Concomitant off-pump coronary artery bypass grafting and bipolar radiofrequency ablation was safe and effective. These patients should be considered for adjunctive treatment at the time of off-pump revascularization.

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