Authors
Borzov E.A. 1, Silaev A.A.2, Vasyagin E.V.2, Kolomeichenko N.A.2, Sukhotin V.N.2, Zorin E.V.2
1 National Medical Research Center of Cardiology named after academician E.I. Chazova, Moscow
2 Clinical Hospital of the Administration of the President of the Russian Federation, Moscow
Abstract
Rationale: Coronary artery bypass grafting (CABG) in patients with coronary heart disease (CHD) and atrial fibrillation (AF) can be performed in combination with surgical ablation of arrhythmogenic areas of the heart. Current clinical guidelines consider the possibility of simultaneous intervention with class IIa, which is a consequence of the lack of a sufficient evidence base.
Objective: to evaluate the effectiveness and safety of CABG and ablation in the modification «Labyrinth IV».
Materials and methods. A prospective randomized study was performed. The study group with simultaneous surgical treatment of coronary heart disease and AF included 111 patients (CABG+RFA group), the control group with isolated CABG included 110 patients (CABG group). Hospital and yearly outcomes were assessed. The end point was AF recurrence. The end point at the post-hospital stage (6 and 12 months after surgery) was assessed using 24-hour ECG monitoring. A comparative analysis of the results in both groups was performed.
Results: Initial clinical and demographic parameters in both groups did not differ, most patients were men over 60 years of age. The duration of surgical treatment in terms of myocardial ischemia time and duration of cardiopulmonary bypass was higher in the CABG+RFA group. At the hospital stage, in the CABG + RFA group, temporary pacing was required somewhat more often, while there were no significant differences in the need for implantation of a permanent pacemaker. “Freedom” from AF recurrence at the hospital and post-hospital stages was significantly higher in the CABG+RFA group, the most significant differences were obtained at the 12-month follow-up stage (96.3% vs. 57.3%, p<0.05). CABG+RFA is accompanied by a significant decrease in the size of the left atrium (LA), while the large size of the LA increases the risk of AF recurrence in the post-hospital period.
Conclusion: Simultaneous CABG and RFA compared with isolated CABG is characterized by a high degree of «freedom» from angina recurrence. The safety of surgical ablation is regarded as satisfactory.
Keywords: coronary artery bypass grafting, atrial fibrillation, radiofrequency ablation, simultaneous coronary artery bypass grafting and radiofrequency ablation.
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