Rhythm course over 5 years following surgical ablation for atrial fibrillation

Abstract

OBJECTIVES: Reporting methods for surgical ablation (SA) of atrial fibrillation (AF) were standardized by the Heart Rhythm Society Guidelines, stating that results should be reported only for the first 2 years following SA. The purpose of this study was to assess the outcome of SA over 5 years and determine predictors for success over that period. METHODS: Data were collected prospectively for all SA (n = 787). Rhythm was verified by electrocardiogram and Holter monitoring at 3, 6, 9, 12, 18 and 24 months and yearly thereafter. Patients with rhythm status available at 2 and 5 years were included in the main analyses (n = 137). Multivariate logistic regression was used for predictors of normal sinus rhythm (NSR). Receiver operating curves compared 2- and 5-year predicted probability against observed rhythm status by year. RESULTS: Return to NSR at 2 years was 88% (80% off antiarrhythmic drugs) and at 5 years was 85% (71% off antiarrhythmic drugs). The majority of patients (64%) had stable NSR over 5 years. The only predictor for 2-year NSR was smaller left atrial size (odds ratio [OR] = 0.40, P = 0.044). Predictors for 5-year NSR were smaller left atrial size (OR = 0.28, P = 0.002), age (OR = 0.91, P = 0.031) and length of hospital stay (OR = 0.85, P = 0.026). CONCLUSIONS: This study demonstrated stable results of SA for AF over time with somewhat different predictors for 2- and 5-year NSR in a group of patients with complete follow-up at both time points. Accurate models to determine predictors for success of SA more than 2 years after surgery are essential to better understand long-term outcome for patients with AF.