Prevalence of ERAT after surgical AF ablation
There are limited data available on the occurrence of ERAT after
surgical AF ablation. Our study is the first to validate the blanking
period after surgical AF ablation. Few studies reported the prevalence
of ERAT after surgical AF ablation. 6,10-13 Benussi et
al.13 studied the prevalence of ERAT in 132 patients
undergoing surgical AF ablation. ERAT occurred in 49.2% of patients,
and the one-year freedom for AF recurrence was significantly lower in
patients with in-hospital postoperative arrhythmias. However, previous
studies were insufficient to estimate the prevalence of ERAT after
surgical AF ablation because the total number of patients was relatively
small and data collection was limited to within the postoperative stay.
For these reasons, unlike catheter ablation, ERAT within a 3-month
blanking period after surgical AF ablation has not been established.
Postoperative AF is the most common atrial arrhythmia after cardiac
surgery and is usually a transient condition that resolves
spontaneously.14 Cardiac surgery itself provides
extensive arrhythmogenic substrates with pre-existing cardiac fibrosis
for triggering and perpetuating AF during the perioperative
period.15-17 At the same time, concomitant surgical AF
ablation with cardiac surgery also causes the modification of
arrhythmogenic substrates, such as triggered activity of the pulmonary
veins or re-entry-promoting structural and electrical remodeling. The
positive and negative effects of ERAT occurred in the immediate
post-operative phase. Unlike several studies on the blanking period of
catheter AF ablation,18-20, our study included mostly
patients undergoing cardiac surgery, such as valve repair or replacement
and coronary artery bypass grafting. Therefore, there may be a drawback
in simply accepting the blanking periods after surgical AF ablation
based on the blanking periods after catheter ablation. Nevertheless,
approximately half of the patients (49%) experienced ERAT within the
first three months following surgical AF ablation, which is consistent
with prevalence rates between 15.9% and 65% of patients with catheter
AF ablation in previous studies.16-18 Previous studies
showed that ERAT occurred in the majority of patients within the first
month after catheter AF ablation, and it gradually decreased; almost all
ERAT occurred within the first two months. 18,20 Our
data founded that ERAT occurred in more than half of the total number of
patients (65 patients) within the first month and slightly rebounded up
to 37.8% in the third month after the index procedure.