Surgical and interventional ablation of atrial fibrillation: comparative analysis of efficacy

Olga Bockeria, Leo Bockeria, Gyulsuna Yurkulieva, Anna Satyukova, Mikhail Biniashvili, Artak Ispiryan

A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of Russian Federation Ministry of Health, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – A

Abstract

Objective: To compare the efficacy of interventional and surgical treatment of atrial fibrillation (AF).

Methods: 73 patients divided into two groups: the first group included 43 patients (59%) after the Labyrinth IIIB procedure (patent number RU2017120391; from date 09.06.2017); the second group included 30 patients (41%) after the radiofrequency ablation of right isthmus and pulmonary veins with the additional line to the mitral valve (MV). The duration of AF was 5.35±3.73 years in group 1, 6.17±4.35 years in group 2 (p=0.39). The MV fibrous ring diameter was 4.33±1.47 and 3.44±1.3 (p=0.02), with MV regurgitation 2.5±0.5 and 1.5±0.5 (p=0.08); the tricuspid valve (TV) fibrous ring diameter was 4.58±1.34 and 3.65±1.3 (p=0.05), with TV regurgitation – 3.0±0.5 and 2.0±0.5 (p=0.06) in first and second groups respectively.

Results: No surgical or interventional related complications were noted. Hospital mortality was 0% in both groups. During the 12.27±1.66 months follow-up period there was no thromboembolic events. After the surgery, MV fibrous ring diameter was 3.25±0.8 and 3.21±1.4 (p=0.04), MV regurgitation 1.0±0.5 and 1.5±0.5 (p=0.06); TV fibrous ring diameter was 3.34±1.23 and 3.44±1.8 (p=0.01), TV regurgitation – 1.5±0.5 and 2.0±0.5 (p=0.08) in first and second groups respectively. The freedom from left atrial arrhythmia after 12 months, was 70.6% in group 1 and 29.4% in group 2 (p=0.03). In early postoperative period 13 patients (30.2%) from group 1 and 17 patients (56.7%) from group 2 have paroxysms of AF with the use of cardioversion to restore the sinus rhythm.

Conclusions: In case of persistent form of AF and left atrium enlargement, the Labyrinth IIIB procedure is a more effective method in reducing arrhythmia recurrences and controlling heart rate. With a comprehensive postoperative assessment, the Labyrinth IIIB procedure is characterized by better long-term results in comparison with interventional methods.