الفهرس 
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Abstract
AF (atrial fibrillation) is the most common sustained arrhythmia, it occurs in 6% of the population aged >65 years. AF contributes to increased risk of anticoagulation related haemorrhage, systemic thromboembolism, and mortality. Indeed, it is the most common cause of stroke in the elderly. Restoration of sinus rhythm with AF correction surgery has many benefits including; avoidance of anticoagulation with the associated bleeding complications, decreased risk of systemic thromboembolism and subsequent stroke, improvement of quality of life, and reduction in the overall mortality.
The classic “cut and sew” Maze 3 procedure is the gold standard surgical treatment of AF. It provides the highest rate of freedom from AF with 97% success rate at a mean follow-up of 5.4 years. However, because of its technical complexity and significant prolongation of the cross-clamp time, it did not gain a widespread acceptance. In order to make the operation faster and simpler, the original cut and sew lesions has been replaced by ablation lines using different energy sources, the most frequently used energy source is the bipolar radiofrequency device.
The aim of this work is to determine the Predictors of successful restoration of sinus rhythm after AF ablation surgery. And whether restoration of sinus rhythm is associated with restoration of the atrial contraction. The study was carried out in Morriston hospital in UK.
All patients who underwent AF ablation surgery for their AF, in concomitant with their cardiac surgery, from the year 2008 throughout 2016 under one consultant in Morrison hospital in UK were included.
All the patients who had radiofrequency ablation for their atrial fibrillation with their concomitant cardiac surgery had 12-lead ECG within one week prior to surgery to confirm the rhythm as being atrial fibrillation. The duration of preoperative atrial fibrillation was documented. Post-operative ECHO is done to determine the E/A ratio and the restoration of atrial contraction.
This study was carried on 129 patients, 76 of them were males and 53 were females. Age of the patients included in this study ranged between 41 years and 89 years. the patients were divided according to their rhythm status at 6 months into two groups. Sinus group included 87 patients, and the AF group included 42 patients. All perioperative parameters were collected. The results were tabulated and analysed.
We found that the significant predicting factors for the restoration of the sinus rhythm were; left atrial diameter (p=0.004), rhythm at discharge (P=0.020), type of
pre-operative AF (P=0.005), and the duration of AF (P<0.001). The remaining perioperative parameters were not a significant factor in predicting the outcome of restoration of sinus rhythm after AF ablation surgery.
We found that 86 patients out of the 87 patients who restored their sinus rhythm restored their atrial function as well, this is statistically significant.
We concluded that the significant predicting factors for successful restoration of sinus rhythm after AF ablation surgery are the following: the duration of AF before surgery, the shorter the duration, the more successful the outcome. The LA diameter, the smaller the left atrium, the more successful the outcome. The type of AF, being paroxysmal is a significant predicting factor for improved outcome. The rhythm at discharge, being sinus rhythm, is a significant predictor factor for the restoration of the sinus rhythm. We also concluded that restoration of the sinus rhythm is associated with significant restoration of the atrial function.