Concomitant Atrial Fibrillation Radiofrequency Ablation During Total Thoracoscopic Valve Replacement: Safety, Early-Term Efficacy, and Predictors of Early Atrial Arrhythmia Recurrence

Abstract

Background: Atrial fibrillation (AF) complicates cardiac surgery, including valve replacements, increasing perioperative risk and impacting long-term outcomes. Concomitant radiofrequency ablation (RFA) during cardiac surgeries shows promise for managing AF. This study investigates the safety, early efficacy, and predictors of atrial arrhythmia recurrence (AAR) following AF RFA during total thoracoscopic valve replacement (TTVR).

Methods: This retrospective observational study included 625 patients who underwent TTVR with concomitant AF RFA from January 2017 to May 2023. Demographic data, preoperative characteristics, operative details, and postoperative outcomes were collected. The primary outcome was AAR within 3 months postoperatively.

Results: Of the 625 patients, AAR was observed in 21.6% (135 patients), with a median time to recurrence of 45 days. Independent predictors of early AAR included age, AF duration, body mass index (BMI), AF type, left atrial diameter, and ablation extent. Notably, persistent and long-standing persistent AF, a larger left atrial diameter, and ablation of the left atrium alone were associated with higher recurrence risks. The in-hospital mortality rate was 1.6%, with no significant differences in early complications between the recurrence and nonrecurrence groups.

Conclusions: Concomitant AF RFA during TTVR is a safe and effective strategy for managing AF in minimally invasive valve surgery. Early predictors of AAR include age, AF duration, BMI, AF type, left atrial diameter, and ablation extent. Future multicenter studies with longer follow-ups are needed to validate these findings and provide robust evidence on long-term outcomes.