Introduction: In patients with long-term history of paroxysmal atrial fibrillation (AF) a decision can be made to go for concomitant coronary artery bypass grafting (CABG) and epicardial AF ablation procedures. Whether patients with recent onset of PAF might benefit of epicardial AF ablation concomitant to CABG is not known. Aim of this prospective, randomized, single-center pilot study is the comparison of patients with first diagnosed AF submitted to CABG and treated with and without epicardial pulmonary vein isolation (PVI).
Methods: Patients with first diagnosed paroxysmal AF and indication for CABG were enrolled in this prospective randomized pilot study. The primary endpoint was AF free survival (AF burden <0.5%) between two groups at 18 months follow up. The secondary end-points were: the percentage of AF burden defined through continuous monitoring using an implantable loop recorder, thromboembolic events and procedural complications. All patients were implanted with a subcutaneous cardiac monitor to track the cardiac rhythm and measure the AF burden.
Results: This study enrolled 43 patients (mean age 59±7 years, 74% males), followed up for 18 months after CABG. The patients were randomly allocated to two groups, CABG alone (n=21) and CABG with concomitant PVI (n=22). At the 18 - month follow-up after surgery, 19 (86%) patients in the CABG+PVI group were AF-free (i.e. AF%<0.5%) vs 9 (43%) in the CABG only group (Log-Rank test, p=0.007). At the end of follow-up, the mean AF burden in the CABG and CABG+PVI group was 7.8±5.1% and 1.6±1.8%, respectively (P<0.001). Four (26%) of the 15 patients with AF recurrences were completely asymptomatic.
Conclusions: Patients with recent-onset atrial fibrillation submitted to CABG may benefit of concomitant ablation of the arrhythmia for preventing recurrences.