The impact of surgical ablation for atrial fibrillation in high-risk patients

Data reported by The Society of Thoracic Surgeons adult cardiac surgery database demonstrate that only 38% of patients with atrial fibrillation (AF) underwent a concomitant surgical ablation. Surgeons are reluctant to add complexity and potential morbidity by including an additional procedure when performing surgery in higher operative risk patients. We investigated perioperative and long-term outcomes in high-risk patients who underwent open heart surgery with or without surgical ablation for AF.

An additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) higher than 6 defined high-risk patients. Perioperative outcomes were captured prospectively, and long-term survival and quality of life were assessed. Propensity score matching using a 0.25 caliper was conducted between the surgical ablation group and the nonablation group (no history of AF).

The propensity score matching analysis included 178 patients per group. The groups were similar on preoperative characteristics including age, ejection fraction, EuroSCORE, and surgical procedures. The perioperative outcomes were similar between groups, including length of stay, permanent stroke, renal failure, 30-day readmissions, and operative (<30 days) mortality. Cumulative survival over 5 years also did not differ between groups (74.4% versus 69.7%, p=0.34).

The addition of an AF surgical ablation procedure did not add operative risk to patients considered high risk, and potentially improved long-term outcome for the subgroup of patients who had their AF ablated. This study suggests that the degree of surgical risk should not be the only decision factor when evaluating this challenging group of patients for surgical ablation.