In several retrospective studies analysing whether existing preoperative atrial fibrillation ( AF ) is a risk factor for a poorer outcome, it was shown that while atrial fibrillation did not seem to have any effect on in-hospital mortality, it did increase the risk of late death or cardiovascular related readmissions by 55% according to a large retrospective analysis including 9796 patients.

A recent retrospective analysis demonstrated that the 5 year survival rate was significantly higher in patients with sinus rhythm preoperatively ( 86.8% ) as compared with those who suffered from atrial fibrillation ( 67.1% ).

According to several retrospective studies and large databases, concomitant atrial fibrillation ablation seems to lower the rate of atrial fibrillation recurrences and the risk of thromboembolic events, which has resulted in new recommendations in the AF guidelines, stating a Class IIA recommendation but still a level of evidence C, indicating the lack of randomised trials.

In patients with persistent atrial fibrillation, a new technology delivers bipolar radiofrequency ( RF ) ablation epicardially for the creation of a left atrial box lesion combined right atrial lesions and endocardial lesions when needed.
After 28 months follow up, there was a 90% freedom from atrial fibrillation with a very low complication rate.

Another hybrid technique with thoracoscopic bipolar RF ablation lesions epicardially combined with conventional endocardial catheter based RF lesions for the creation of a box lesion, mitral line and in some cases right sided lesions, reported freedom from atrial fibrillation in 85-92% of cases. The rate of left atrial reentrant tachycardias was less than 5%.

A new surgical device using a left percutaneous epicardial atrial appendage ligation with closed chest reported a 96 % success rate in obtaining complete ligation without residual cavities. ( Xagena )

Source: European Society of Cardiology ( ESC ) Congress, 2013

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