Korean J Thorac Cardiovasc Surg 2019; 52(2): 61-69  https://doi.org/10.5090/kjtcs.2019.52.2.61
Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement
WonKyung Pyo , M.D., Sung Jun Park , M.D., Wan Kee Kim , M.D., Ho Jin Kim , M.D., Joon Bum Kim , M.D., Ph.D., Sung-Ho Jung , M.D., Ph.D., Suk Jung Joo , M.D., Ph.D., Cheol Hyun Chung , M.D., Ph.D., Jae Won Lee , M.D., Ph.D.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author: Jae Won Lee, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
(Tel) 82-2-3010-3584 (Fax) 82-2-3010-6966 (E-mail) jwlee@amc.seoul.kr
Received: September 7, 2018; Revised: October 25, 2018; Accepted: November 1, 2018.; Published online: April 5, 2019.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement.
Methods: From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes.
Results: During 49.1 months of follow-up (interquartile range, 22.5–96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02–1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22–7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00–1.05; p=0.045) were significantly associated with AF recurrence.
Conclusion: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.
Keywords: Arrhythmia surgery, Anticoagulants, Bioprosthesis, Atrial fibrillation, Surgical ablation


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