Page 40 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Chapter 2
Discussion
Background characteristics
The main prospective, randomized trial of 150 patients showed that 57.1% of patients in the add-on surgery group versus 41.9% in the standard surgery group were successfully treated for AF. Several reports on rhythm outcome after similar techniques of left atrial ablation lesions showed success rates of 71-100%10,15-17 in restoration of SR, mainly in paroxysmal atrial fibrillation (pAF) patients18-20. Rhythm restoration success is largely related to the type of pre-operative AF21 and whether add-on surgery was performed on a concomitant procedure22. Also in our study patients with pre-operative pAF showed a significantly higher percentage of SR restoration (81.5% in the add-on surgery group versus 57.7% in the control group). These findings suggest that pAF patients benefit most of adjuvant ablation surgery as rhythm restoration is concerned. Permanent or persistent AF-patients, who have many risk factors, show significantly less resumption of SR. Therefore add-on surgery should not be offered to all AF- patients in a routine manner during cardiac surgery. No beneficial effect on morbidity and mortality of add-on surgery could be demonstrated. Particularly, there was no reduction in stroke incidence. Up till now, only one study has been able to demonstrate the beneficial role of adjuvant AF-ablation on postoperative mortality23.
Health-related quality of life measurements
The present study confirms the outcome of previous trials: overall HrQoL improved after cardiac surgery24-25. The RAND SF-36 showed significant improvement in all scales during follow-up without significant differences between groups.The EuroQoL (VAS and EQ-5D) on the other hand showed no significant improvement in HrQoL. As a generic measurement the EQ-5D and VAS may be too insensitive to assess specific conditions as AF. Surprisingly, the Pain/Discomfort scale in the EQ-5D showed a significant deterioration during follow-up (p= .012). This might well be a result of a Type I error. But Lahtinen et al. showed that chest pain after cardiac surgery at 1-year follow-up ranges from pain at rest (17%) to pain upon movement (31%)26, while others reported incidences of post-sternotomy pain ranging from 38-56%27-28. Furthermore, anxiety and depression are supposed to interact with chronic postoperative pain after cardiac surgery29, although in the present study Pain/Discomfort can not be
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