A Study Of Clinical Efficacy Of Novel Atrial Fibrillation Elimination Surgery For Atrial Fibrillation

Background: Atrial fibrillation(AF)is a common arrhythmia,and its treatment has been a research focus recently.The Novel Atrial Fibrillation Elimination Surgery developed at our institute presents good early clinical outcomes.However,this surgery still lacks long-term follow-up to evaluate its clinical efficacy.In this study,we studied whether this surgery is able to present satisfactory clinical outcomes during long-term follow-up.Methods: From November 2017 to November 2019,seventy-eight patients with persistent or long-standing AF scheduled for cardiac surgery were included.The surgery is mainly a left-sided surgery including surgical posterior wall isolation(PWI),epicardial left atrial appendage ligation and left atrial geometric volume reduction.Left atrial structure and function was assessed by measuring left atrial diameter and left atrial emptying fraction(LAEF)through transthoracic echocardiography and rhythm monitoring is evaluated by ECG and 24h-Holter at pre-and postoperative period and at 1-year follow-up.Record all the major cardiovascular adverse events.The receiver-operating characteristic curve was plotted to identify echocardiographic cut-off values that would predict successful procedure.All the data were analyzed.Results: At 1-year follow-up,total sinus rhythm(SR)maintenance was 80.7%(63/78).Left atrial anterior-posterior diameter(LAD)reduced from 54.0±10.1mm to39.7±6.7mm(p<0.001).Maximal left atrial volume(LAVmax)decreased from204.8±177.9ml to 89.5±37.6ml(p<0.001).Left atrial emptying fraction(LAEF)increased from 20.5±11.8 % to 31.5±7.4%(p<0.001).LAEF of patients who maintained SR increased from 22.2±12.2 % to 34.0±5.2%(p<0.001)and that of patients who were failed to maintain SR increased from 13.4±6.5 % to21.2±6.3 %(p=0.007).When LAEF is used as a predictor for successful procedure,whose AUC=0.960(95% CI:0.894–1.000),patients with a LAEF>25.2%demonstrated favorable lower AF recurrence rate compared to those with a LAEF<25.2% at 1-year follow-up based on ROC curve.One patient was implanted permanent pacemaker due to sick sinus syndrome.No other severe adverse events were observed at follow-up.Conclusion: The Novel Atrial Fibrillation Elimination Surgery is a lesion-simplified surgical innovation and shows efficacy for AF with a satisfactory SR maintenance at1-year follow-up.Left atrial structure and function improves in early post-procedural stage and this benefit continues at 1-year after surgery.The post-procedural LAEF level is positively correlated with SR maintenance.