Content area
Full Text
INTRODUCTION
Surgical ablation of atrial fibrillation (AF) is recommended in patients (Class IIA) undergoing cardiac surgery[1]. Adjunct ablation of cardiac autonomic ganglionated plexi (GP) may additionally reduce AF recurrence. However, there is no clear data on its effectiveness, though this technique was introduced a decade ago[2]. The only GP ablation surgical technique introduced to cardiac surgery is based on previous epicardial detection by inducing vagal reflex with rapid stimulation. The stimulation of GP results in rapid acetylcholine secretion and subsequently elicited vagal reflex (transient bradycardia, conduction block)[3]. Therefore, only detected GP are ablated in that technique.
Anatomical studies showed that most GP are located within the epicardial fat pads covering the entire antrum of the pulmonary veins (PVs) and the interatrial groove. There is no data showing absence of GP in certain individuals[4]. The success rate of detection and the number of detected GP vary in the studies published thus far, and even more limited data is available on the predictors of successful GP detection during surgical ablation of AF[5,6]. The primary aim of this study was to analyze the preoperative factors corresponding to successful GP detection and the number of detected GP in patients undergoing AF ablation concomitantly to surgical coronary revascularization. The secondary aim was to search for a correlation between GP detection and early recurrence of AF.
METHODS
Study Population
The study involved 34 consecutive patients with persistent and long-standing persistent AF and coronary artery disease referred for surgical revascularization with concomitant left atrial ablation and left atrial appendage epicardial occlusion. No inclusion or exclusion criteria were introduced for this study since all patients with AF referred to surgical revascularization are qualified for off-pump coronary artery bypass grafting with concomitant left atrial ablation and left atrial appendage occlusion in our center. All patients had a high stroke risk according to the CHA2DS2-VASc score (mean score of 3.8±1.6) as well as an increased risk of bleeding on oral anticoagulants, with an average HAS-BLED score of 3.1±1.3 (Table 1). The study protocol was approved by the Institutional Ethics Committee and all patients signed informed consent before surgery.
Table 1 Patient characteristics.
[...