Restoring sinus rhythm in patients with previous pacemaker implantation submitted to cardiac surgery and concomitant surgical ablation of atrial fibrillation

Objective: Some patients submitted to cardiac surgery have concomitant atrial fibrillation and a previously implanted pacemaker. Because it is unknown if there is any potential for these patients to reassume a regular rate sinus rhythm after ablation of atrial fibrillation, we reviewed the results of all patients with pacemaker enrolled in the Registry of Atrial Fibrillation. Materials: Thirty-six patients were included in this study. Twenty-six had valve disease, seven had coronary disease and three had congenital heart disease. They were submitted concomitantly to ablation of atrial fibrillation using biatrial approaches (seven patients), left sided (27), or right sided (three patients). Thirty-three hospital survivors had a mean follow-up of 18 months, and a maximum of 25 months. Results: At 1 year (n = 21), patients' rhythm was sinus non-pacing dependent (52%), sinus pacing-dependent (14%), and atrial fibrillation (14%). At 2 years (n = 14), patients' rhythm was sinus non-pacing dependent (57%) and atrial fibrillation (43%). The only factor that may have had impact on the recovery of sinus rhythm at 1 year was the small size of the left atrium (p = 0.05). Conclusions: We conclude that in a significant number of patients, having a pacemaker before surgery does not preclude sinus rhythm recovery after a cardiac operation and ablation for concomitant atrial fibrillation.