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Background/Objectives: The present study introduces our targeted approach for concomitant surgical ablation (CSA) using non-invasive phase mapping (NIPM) and describes its effectiveness regarding freedom from atrial fibrillation (AF). Methods: This retrospective study included cardiac surgical patients undergoing preoperative NIPM for CSA guidance. The primary outcome was freedom from AF six months after surgery. Key secondary outcomes were freedom from AF at hospital discharge and three months, frequency of biatrial ablation, feasibility and safety, the rate of CSA, complications, and levels of biomarkers. The control group consisted of patients undergoing CSA without NIPM. Results: Forty-four patients (Control: n = 31/NIPM: n = 13) were included. The NIPM group was younger (64 vs. 71 years [p = 0.044]), had a lower EuroSCORE II (2.6 vs. 3.4 [p = 0.041]), and a smaller left atrial size (46 mm vs. 54 mm [p = 0.025]). Surgery duration was longer in the NIPM group (285 vs. 230 min [p = 0.037]) with similar aortic cross-clamp times. Preoperative NIPM resulted in an effective frequency of CSA of 93%. CSA was more extensive in the NIPM group, with biatrial ablation performed in 54% vs. 26% of patients (p = 0.09). Conclusions: Routine preoperative NIPM in patients with non-paroxysmal atrial fibrillation might aid in increasing the number of patients receiving concomitant surgical ablation and developing a personalized CSA approach for every patient. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation after cardiac surgery (NOAF) is a frequent complication and is associated with postoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. The structures maintaining NOAF are mainly unknown. Thus, the present study aims to describe electrophysiological patterns of NOAF that might be future therapeutic targets. We present preliminary data from an ongoing prospective single-center cohort study of patients developing NOAF. We have included consecutive patients undergoing cardiac surgery and monitored them for the first seven postoperative days for the development of NOAF. Patients presenting with NOAF underwent non-invasive electrophysiological mapping using a 252-electrocardiogram vest to identify focal and rotational potential drivers (PDs) of NOAF. After mapping, a computed tomography scan of the chest was performed to generate a 3-dimensional model of the atria, where the PDs were projected, thus allowing a visual identification of NOAF maintaining structures. The primary outcome was the electrophysiological description of PDs of NOAF and NOAF-maintaining structures within the atria. Of 205 enrolled patients, 62 (30%) developed NOAF. Electrophysiological mapping was performed in 23 NOAF patients (37%). A median of 29 (21-48[IQR]) rotational PDs and a median of 26 (20-35[IQR]) focal PDs were identified per patient. The most frequent localizations of rotational drivers were the upper half of the right atrium (23 patients, 100%), the inferior/posterior left atrium (22 patients, 96%), and the left pulmonary veins (22 patients, 96%). The most frequent localizations of focal drivers were the upper half of the right atrium (22 patients, 96%), the left (22 patients, 96%), and right pulmonary veins (20 patients, 87%). Based on these preliminary results, structures such as the upper right atrium might play a role in maintaining NOAF and thus be targets for future preventive or therapeutic strategies. As the study is ongoing with the opening of a second study center in 2024, more precise results allowing identification of risk factors for specific PD locations and associations with outcomes are expected. [ABSTRACT FROM AUTHOR]