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Right Atrial Lesions Do Not Improve the Efficacy of a Complete Left Atrial Lesion Set in the Surgical Treatment of Atrial Fibrillation, But They Do Increase Procedural Morbidity
Study Questions:
What is the incremental value of right atrial (RA) lesions in patients undergoing surgical ablation of atrial fibrillation (AF)?
Methods:
This was a retrospective analysis of 305 patients (mean age 65 years) who underwent surgical ablation of AF (paroxysmal in 32%). The lesion set was at the operator’s discretion. Left atrial (LA) ablation was categorized as pulmonary vein isolation (PVI) or extended-LA ablation (PVI + a line to the mitral annulus ± LA appendage exclusion). RA ablation consisted of an intercaval line plus lines to the tricuspid annulus and along the anterior wall. A variety of energy sources was used, most often cryoenergy or radiofrequency energy. Efficacy was based on 12-lead electrocardiograms at 3-month intervals. Use of antiarrhythmic drugs was not taken into account when judging efficacy.
Results:
The efficacy at 12 months was significantly higher with extended-LA ablation (76%) than with PVI (53%), and did not differ significantly between biatrial ablation (80%) and extended-LA ablation (76%). The need for a permanent pacemaker was significantly higher with (16.5%) than without (7.5%) RA ablation.
Conclusions:
Additional RA ablation in patients undergoing extended-LA surgical ablation of AF does not improve efficacy and increases the need for a permanent pacemaker.
Perspective:
Prior studies on the value of RA ablation in patients undergoing various types of surgical LA ablation of AF have reported mixed results. Because of major problems with the study design (i.e., retrospective, nonrandomized, efficacy based only on clinic electrocardiograms, no data on antiarrhythmic drug use), this study does little to resolve the controversy.
Keywords: Heart Atria, Atrial Appendage, Pulmonary Veins, Pacemaker, Artificial, Electrocardiography, Catheter Ablation
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