Comparative analysis of the requirement for pacemaker implantation in the left atrial and biatrial concomitant ablation in patients with valvular heart disease
Objective. Atrial fibrillation (AF) is an independent risk factor affecting overall mortality. Concomitant surgical ablation of AF effectively restores the sinus rhythm and improves the quality of life. To date, there is no consensus on the optimal atrial fragmentation scheme for the treatment of AF in patients undergoing cardiac surgery. The purpose of this study is to compare the influence of left atrial and biatrial ablation on the frequency of pacemaker implantation in patients with persistent and long-standing persistent AF undergoing open heart surgery. Material and methods. Between January 2007 and December 2016, concomitant ablation was performed in 898 patients with valvular heart disease and AF, as planned, during the correction of valvular pathology. After exclusion of patients with paroxysmal AF 588 consecutive patients with either persistent (20.9%) or longstanding persistent (79.1%) AF were enrolled in the study. To reduce between-group differences, propensity score-matched groups (156 patients per group) were obtained, with similar preoperative and perioperative characteristics. The average duration of long-term monitoring was 37.3±34.1 months in left atrial lesion set group and 37.1±34.2 months in biatrial lesion set group. Evaluation of the rhythm was carried out using 24-hour Holter monitoring. Indications for implantation of the pacemaker included symptomatic syndrome of weakness of the sinus node (heart rate less than 60 beats per minute without adequate adaptation to physical activity) and some disorders of atrial-ventricular conduction. Results. After propensity score matching, biatrial lesions set in comparison with left atrial lesions set was associated with higher pacemaker implantation rate (17.3% vs. 3.8%; p<0.001). The main reason for the higher demand for pacemaker implantation in the performance of biatrial lesions set was the higher frequency of sinus node dysfunction. There was no significant between-group difference regarding the incidence of atrioventricular conduction disturbances (7.0% vs. 3.2%, respectively; p=0.211). Conclusion. Biatrial ablation was associated with higher incidence of sinus node dysfunction and higher rate of pacemaker implantation.