Map Guided Surgical Ablation of Atrial Fibrillation in Combination with Coronary Artery Bypass Grafting on Beating Heart

Methods: from March 2016 to June 2017, concomitant surgery for AF ablation and CABG performed on 11 patients. Paroxysmal AF was observed in 5 patients (45.5% of cases), persistent in 6 patients (54.5%). The arrhythmia was investigated by 3D electroanatomical NavX mapping before the operation. Operations performed through median sternotomy on pump beating heart condition. On the first stage, the electrical isolation of the pulmonary veins was performed in pairs (left and right). In 4 cases additional ablation of the base of the LA appendage was performed. On the second stage was performed the CABG.

Results: Hospital mortality was 0%. In 4 cases the additional ablation of LA appendage was performed according to 3D electroanatomical mapping. The average number of grafts was 2.4±1,1. In all cases the intraoperative angiography showed satisfactory patency of the grafts. 1 patient (9.01%) experienced atrial flutter during the early post operation period with the use of cardioversion and interventional therapy to restore the normal rhythm. At the time of discharge and during the 6 month follow up all patients patients (100 %) had stable sinus rhythm. No thrombo-embolic events observed during follow-up. Pacemaker implantation was not required.

Conclusions: Map guided surgical ablation of AF in combination with CABG on a beating heart is an effective and safe method for the treatment of AF with concomitant coronary artery disease. Our experience supports wider use of combined methods of surgical AF ablation and CABG. The use of electroanatomical 3D NavX navigation mapping may have in the future the important role to determine the volume of surgical ablation of AF for each individual patient.