M. Knaut1, S. Norkus1, S. M. Tugtekin1, S. Brose1, F. Jung2, K. Matschke1
1Department of Cardiac Surgery, University of Technology Dresden, Dresden, Germany; 2Center for Biomaterial Development and Berlin Brandenburg Center for Regenerative Therapies (BCRT), GKSS Research Center Geesthacht GmbH, Teltow, Germany
[Applied Cardiopulmonary Pathophysiology 13: 277-283]
Background: Patients with permanent atrial fibrillation have a clearly higher risk for thromboembolic events than people with sinus rhythm. Because also anticoagulant therapy, which is the therapy of choice in chronic atrial fibrillation, has its risks, intra operative ablation therapy as a concomitant procedure has become more and more important. Nevertheless this option is not available for all patients and little is known whether the operation by its self is able to restore sinus rhythm and about the fate of these patients. Therefore we created a registry to follow the clinical course of patients with atrial fibrillation after heart surgery.
Method: All consecutive patients with permanent atrial fibrillationwho were operated in our center and who were not eligible for ablation therapy were included into the registry. The patients were monitored up to postoperative month 12 with regard to their clinical outcome especially rhythm course and survival. These data were evaluated during in-hospital visits 30, 90, 180 and 360 days after operation.
Results: A total of 287 (151 male/136 female) consecutive patients with permanent atrial fibrillation were included into the registry.
During the follow-up period, approximately 10% of the patients converted to sinus rhythm. 13 patients, or 4.9%, were in stable sinus rhythm, which means that they were in sinus rhythm at every follow-up visit.
30-day mortality was 6.9% (20 of 286 patients) while it was 14.9% after one year (43 of 263 patients). Of the 13 patients who were in stable sinus rhythm after one year, only one patient died (7.7%), while of the 185 patients who where still in atrial fibrillation 43 died (23.2%).
Conclusion: Our results demonstrate that also correction of the heart disease by it self is able to restore sinus rhythm in a few patients. Nevertheless the rate of patients with continuous atrial fibrillation was approximately 90%, the rate of stable sinus rhythm, which is suspected to improve prognosis was only 4.9%. Therefore, an attempt to treat atrial fibrillation with intra operative ablation therapy is strongly justified, respecting the fact that, even if conservatively calculated, a success rate of at least 50% can be accomplished. We believe, that this applies even for endocardial and for the epicardial approach.
Key words: permanent atrial fibrillation, spontaneous conversion rate after heart surgery
Address for corresponding:
PD Dr. Michael Knaut, Dresden Heart Institute, Technical University Dresden, Fetscherstr. 76, 01307 Dresden, Germany