Should we change the paradigm in the approach to the treatment of AF during CABG? Single center experience based on a randomized trial

Rationale: Coronary artery bypass grafting (CABG) in patients with coronary heart disease (CHD) and atrial fibrillation (AF) can be performed in combination with surgical ablation of arrhythmogenic areas of the heart. Current clinical guidelines consider the possibility of simultaneous intervention with class IIa, which is a consequence of the lack of a sufficient evidence base. Objective: to evaluate the effectiveness and safety of CABG and ablation in the modification «Labyrinth IV». Materials and methods. A prospective randomized study was performed. The study group with simultaneous surgical treatment of coronary heart disease and AF included 111 patients (CABG+RFA group), the control group with isolated CABG included 110 patients (CABG group). Hospital and yearly outcomes were assessed. The end point was AF recurrence. The end point at the post-hospital stage (6 and 12 months after surgery) was assessed using 24-hour ECG monitoring. A comparative analysis of the results in both groups was performed. Results: Initial clinical and demographic parameters in both groups did not differ, most patients were men over 60 years of age. The duration of surgical treatment in terms of myocardial ischemia time and duration of cardiopulmonary bypass was higher in the CABG+RFA group. At the hospital stage, in the CABG + RFA group, temporary pacing was required somewhat more often, while there were no significant differences in the need for implantation of a permanent pacemaker. "Freedom” from AF recurrence at the hospital and post-hospital stages was significantly higher in the CABG+RFA group, the most significant differences were obtained at the 12-month follow-up stage (96.3% vs. 57.3%, p function show_eabstract() { $('#eabstract1').hide(); $('#eabstract2').show(); $('#eabstract_expand').hide(); }