Efficiency of different techniques of ablation of longstanding persistent atrial fibrillation during coronary bypass surgery

Objective. The purpose of this prospective, randomized, single-center, uncontrolled, open study was to assess the efficiency of surgical treatment of the most common worldwide disease of the cardiovascular system – coronary heart disease (CHD) in combination with atrial fibrillation (AF). Methods. Different techniques of AF ablation in patients with coronary artery disease during coronary bypass surgery were analyzed. 98 patients with longstanding persistent AF were randomized into three groups: PVI+CABG (n = 31) group underwent isolation of the pulmonary veins, the CABG+MM group (n = 37) received a modified mini-MAZE procedure (isolation of pulmonary veins in combination with left isthmus ablation and formation of an ablation line on the roof of the left atrium) and CABG with anatomical ablation of ganglionated plexi zones was performed for the CABG+GP group patients (n = 30). Results. It was found out that in patients with coronary artery disease and longstanding persistent AF, only radiofrequency fragmentation of the left atrium performed during CABG surgery can yield satisfactory results in the long term, with efficiency running up to 48.65%. Predictors of AF return in the patients with longstanding persistent AF are: the size of the left atrium exceeding 6.5 cm (OR 1.18, CI 1.01–1.75; p = 0.043) and a long (over 10 years) AF history (OR 1.07, CI 0.23–5.03; p = 0.038). Conclusion. Ganglionated plexi ablation performed simultaneously with CABG in patients with long standing persistent AF has a low efficiency in the long term (33.3%) and cannot be an independent method of treatment of this form of AF.