Dynamics of clinical/functional status of chd patients after surgical treatment of atrial fibrillation

Background. Coronary heart disease (CHD) and persistent atrial fibrillation (AF) are considered to be the most commonly encountered pathologies in medical practice. Objective. The study was designed to evaluate the efficacy of various methods of AF ablation when performing CABG, as well as the dynamics of clinical and functional status of patients and their quality of life (QoL) in the long-term postoperative period. Methods. The study included 98 patients with long standing persistent AF. The patients were randomized into three groups: CABG+PVI (n=31), CABG+miniMaze (MM) (n=37) and CABG+GP (n= 30). Postoperative complications, echocardiography data and QoL indicators, as well as freedom from AF in the long term period were evaluated at baseline and in 4 years after surgery. Results. The nature of interventions performed and the number of postoperative complications did not differ between the groups. Survival at 3 years in the CABG+PVI group was 96.8%, in the CABG+MM group 100% and in the CABG+GP group 96.7%. Freedom from AF by the 4th year of follow-up in the CABG+PVI group amounted to 38.7%, in the CABG+MM group 48.6% and in the CABG+GP group 33.3%. ECG revealed no statistically significant improvement of linear and volumetric dimensions of the left atrium and left ventricle in the long term. No significant improvement of all QoL indicators was observed during long-term follow-up in all groups. Conclusions. The study demonstrates the safety and efficacy of AF ablation in CHD patients with long-standing persistent AF during CABG surgery. The left atrium size exceeding 6.5 cm and arrhythmia experience of 10 years could serve as predictors of arrhythmia relapse during long-term follow-up.