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Objective: To assess chronotropic competence of restored sinus rhythm (SR) after surgical ablation for chronic atrial fibrillation and its clinical impact.
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Oliver Reuthebuch1, Johannes Holzmeister2, Michele Genoni3.
1Cardiac Surgery, Triemli Spital, Zurich, Switzerland, 2cardiology, University Hospital, Zurich, Switzerland, 3Cardiac Surgery, University Hospital, Zurich, Switzerland.
Methods: 20 patients (14m/6f) in SR (23.4±6.55 months postoperatively) following radiofrequency ablation of the left atrium due to chronic atrial fibrillation underwent bicycle ergometer exercise testing. 15/20 had concomitant mitral valve surgery, 2/20 aortic valve replacement, 1/20 ASD closure, 2/20 CABG . End points were occurrence of clinical symptoms and severe arrhythmia or accomplishing working capacity (male: 2W/kg , female:1.5W/kg), maximum heart rate (male: 210-age, 85%; female: 220-age, 85%) and more than doubled rate pulse product. Change of NYHA classification, need for anticoagulation and antiarrhythmic drugs were evaluated.
Results: During exercise all patients remained in SR. 3/20 (15%) patients showed mild ventricular extrasystolies. No AV-blockage was seen, no supraventricular extrasystolies. Termination was due to tiring legs in all patients. Mean measured exercise capacity was 128.8±33.64 Watts vs. calculated 134.7±27.54 Watts (p=0.51). Maximum accomplished heart rate was 129.05±17.72 beats/min vs. computed 121.95±10.23 beats/min (p=0.14). Mean rate pulse product at rest was 9747.55±1278.6 vs. 22720.6±5515.91 under exercise (p<0.05). Thus, at exercise rate-pulse-product doubled more than twice (2.33).
NYHA classes decreased from 2.85±0.75 to 1.15±0.98 (p<0.05). Only 8/20 ceased anticoagulation, 10/20 antiarrhythmic drugs at time of investigation.
Conclusions: In this study we could reveal restored chronotropic-competent SR after surgical ablation of chronic atrial fibrillation. Even under exercise testing patients remained in stable SR. Patients showed a significant drop of NYHA classes. All patients could have stopped anticoagulation and antiarrhytmic drugs, however the majority was still on medication.
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