Anatomo-electrical analysis of atrial remodelling for long-term success prediction of concomitant surgical ablaton of atrial fibrillation

Objective: To identify preoperative parameters of anatomo-electrical atrial remodelling in order to identify the subgroup of patients more favourable to long-term sinus rhythm (SR) re-establishment after concomitant ablation of persistent-permanent atrial fibrillation (AF). Methods: The study included 50 consecutive patients undergoing concomitant surgical ablation of persistent-permanent AF with cryoablation and bipolar radiofrequency Maze IV pattern. The variables collected before the operation were: demographic variables, morbidity, AF evolution time, transthoracic echocardiographic study, and digital electrocardiogram register for f-wave signal organisation analysis (sample entropy [SampEn]). An assessment was also made of the individual and combined association of atrial remodelling parameters with SR restoration by area under ROC curve (AUC). Results: Follow-up 22.32 +/- 3.19 months. Mean AF onset time 4.00 +/- 4.28 years. Mean left atrium diameter 49.90 +/- 8.18 mm (range = 32 - 81 mm), and SR restoration of 62% at the end of follow-up. Parameters best linked to postoperative SR restoration were left atrium diameter (AUC = 0.848)and SampEn (AUC = 0.845). Cut-off points were 50 mm and 0.0857, respectively, obtaining a model with a predictive accuracy when both parameters combined with an AUC = 0.893. Conclusions: Preoperative anatomo-electrical remodelling analysis through indirect non-nvasive variables could be useful to select patients more favourable to SR restoration after concomitant ablation of AF. (C) 2015 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).