Register
Forgot your password?

Long-term outcomes of concomitant epicardial radiofrequency pulmonary vein isolation in patients undergoing coronary artery bypass grafting

Authors: Dzhamaldinov I.A., Serguladze S.Yu., Lukashkin M.A., Bulaeva N.I., Berdibekov B.Sh., Romanchuk D.V., Danilov G.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2026-20-2-293-301

For citation: Dzhamaldinov I.A., Serguladze S.Yu., Lukashkin M.A., Bulaeva N.I., Berdibekov B.Sh., Romanchuk D.V., Danilov G.V., Golukhova E.Z. Long-term outcomes of concomitant epicardial radiofrequency pulmonary vein isolation in patients undergoing coronary artery bypass grafting. Creative Cardiology. 2026; 20 (2): 293–301 (in Russ.). DOI: 10.24022/1997-3187-2026-20-2-293-301

Received / Accepted:  11.04.2026 / 23.05.2026

Keywords: atrial fibrillation coronary artery disease coronary artery bypass grafting radiofrequency ablation pulmonary vein isolation



Subscribe 🔒

 

Abstract

Objective. To evaluate the outcomes of concomitant radiofrequency ablation (RFA) of the pulmonary vein (PV) ostia performed during coronary artery bypass grafting (CABG), and to identify predictors of atrial fibrillation (AF) recurrence during long-term follow-up.

Material and methods. This retrospective single-arm cohort study included 102 patients with coronary artery disease (CAD) and AF who underwent CABG combined with concomitant epicardial RFA of the pulmonary veins. The mean age was 66.0 ± 6.5 years; 81.3% of patients were male. The primary endpoint was late AF recurrence, defined as any documented episode of atrial tachyarrhythmia lasting 30 seconds or longer after completion of the 90-day blanking period. The median follow-up duration was 29.5 [18.0–37.0] months.

Results. In the early postoperative period, sinus rhythm was observed in 94.1% of patients and was maintained in 93.1% at discharge. During the 90-day blanking period, AF episodes were documented in 31.4% of patients. At 12 months, AF recurrence was observed in 23.5% of patients, while late AF recurrence during long-term follow-up occurred in 33.3%. According to Kaplan–Meier analysis, freedom from AF recurrence at 60 months was 64.0%. In the multivariable Cox model, persistent AF (hazard ratio [HR] 3.12; 95% confidence interval [CI] 1.07–19.21; p = 0.040) and increased transverse left atrial diameter (HR 1.15 per 1 mm; 95% CI 1.03–1.40; p = 0.027) were identified as independent predictors of late AF recurrence.

Conclusion. Concomitant epicardial radiofrequency isolation of the pulmonary vein ostia during CABG was associated with maintenance of sinus rhythm in a substantial proportion of patients during long-term follow-up and with a low rate of serious perioperative complications. Persistent AF and increased left atrial size were independent predictors of late arrhythmia recurrence.

References

  1. Van Gelder I.C., Rienstra M., Bunting K.V. et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2024; 45 (36): 3314–3414. DOI: 10.1093/eurheartj/ehae176
  2. Benjamin E.J., Wolf P.A., D’Agostino R.B. et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998; 98 (10): 946–952. DOI: 10.1161/01.CIR.98.10.946
  3. Aviles R.J., Martin D.O., Apperson-Hansen C. et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003; 108 (24): 3006–3010. DOI: 10.1161/01.CIR.0000103131.70301.4F
  4. Darby A.E., Dimarco J.P. Management of atrial fibrillation in patients with structural heart disease. Circulation. 2012; 125 (7): 945–957. DOI: 10.1161/CIRCULATIONAHA.111.019935
  5. Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu. et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021; 26 (7): 4594 (in Russ.). DOI: 10.15829/1560-4071-2021-4594
  6. Violi F., Soliman E.Z., Pignatelli P., Pastori D. Atrial fibrillation and myocardial infarction: a systematic review and appraisal of pathophysiologic mechanisms. J. Am. Heart Assoc. 2016; 5 (5): e003347. DOI: 10.1161/JAHA.116.003347
  7. Revishvili A.Sh., Popov V.A., Anishchenko M.M. et al. Radiofrequency ablation of pulmonary veins for the prevention of new-onset atrial fibrillation during coronary artery bypass grafting: results of the randomized clinical trial PULVAB. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2025; 67 (3): 332–345 (in Russ.). DOI: 10.24022/0236-2791-2025-67-3-332-345
  8. Revishvili A.Sh., Popov V.A., Aminov V.V. et al. Prediction of the effectiveness of radiofrequency isolation of the pulmonary vein in the treatment of concomitant paroxysmal atrial fibrillation during coronary artery bypass grafting. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65 (6): 702–712 (in Russ.). DOI: 10.24022/0236-2791-2023-65-6-702-712
  9. Wyler von Ballmoos M.C., Hui D.S., Mehaffey J.H. et al. The Society of Thoracic Surgeons 2023 Clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann. Thorac. Surg. 2024; 118 (2): 291–310. DOI: 10.1016/j.athoracsur.2024.01.007
  10. Schaffer J.M., Kluis A., Squiers J.J. et al. Survival after surgical ablation of atrial fibrillation during coronary artery bypass in medicare beneficiaries. Ann. Thorac. Surg. 2025; 120 (4): 693–703. DOI: 10.1016/j.athoracsur.2025.03.044
  11. Bockeria L.A., Semenov V.Yu., Milievskaya E.B. et al. Surgical and interventional treatment of patients with coronary heart disease in Russian Federation (1996–2022). Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (3): 291–301 (in Russ.). DOI: 10.24022/0236-2791-2024-66-3-291-301
  12. Revishvili A.Sh., Popov V.A., Malyshenko E.S. et al. Is Maze V procedure justified for paroxysmal form of atrial fibrillation in combination with coronary bypass grafting surgery? Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (4): 493–507 (in Russ.). DOI: 10.24022/0236-2791-2024-66-4-493-507
  13. Whitlock R.P., Belley-Cote E.P., Paparella D. et al. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N. Engl. J. Med. 2021; 384 (22): 2081–2091. DOI: 10.1056/NEJMoa2101897
  14. Baudo M., Rosati F., Lapenna E. et al. Surgical options for atrial fibrillation treatment during concomitant cardiac procedures. Ann. Cardiothorac. Surg. 2024; 13 (2): 135–145. DOI: 10.21037/acs-2023-afm-0208

About Authors

  • Islam A. Dzhamaldinov, Cardiovascular Surgeon; ORCID
  • Sergey Yu. Serguladze, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
  • Mikhail A. Lukashkin, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Associate Professor, Head of Department, Cardiologist; ORCID
  • Bektur Sh. Berdibekov, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Denis V. Romanchuk, Cardiologist; ORCID
  • Grigoriy V. Danilov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by