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Updated: May 1, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Impact of concomitant surgical atrial fibrillation ablation in patients undergoing aortic valve replacement
Jae Suk Yoo1, Joon Bum Kim, Sun Kyun Ro
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Insights
Concomitant atrial fibrillation (AF) ablation during aortic valve replacement (AVR) improves sinus rhythm and echocardiographic outcomes without increasing surgical risks. This procedure also reduces the need for postoperative anticoagulation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- The clinical value of performing atrial fibrillation (AF) ablation concurrently with aortic valve replacement (AVR) remains unclear.
- Uncertainty exists regarding the benefits and risks of combining these procedures.
Purpose of the Study:
- To evaluate the clinical benefit of concomitant AF ablation during AVR.
- To compare outcomes between patients undergoing AVR with and without AF ablation.
Main Methods:
- A retrospective analysis of 124 patients undergoing AVR between 2000 and 2011.
- Patients were divided into two groups: AVR with concomitant maze procedure (n=50) and AVR alone (n=74).
- Outcomes assessed included early postoperative results, late mortality, valve-related complications, and sinus rhythm restoration.
Main Results:
- No significant differences in early postoperative outcomes or major adverse cardiac events were observed between the groups.
- The maze group showed significantly higher rates of sinus rhythm restoration at 4 years (80.6% vs. 3.6%).
- The maze group had smaller left atrial dimensions, higher ejection fraction, and lower rates of postoperative anticoagulation compared to the AVR-alone group.
Conclusions:
- Concomitant AF ablation during AVR improves sinus rhythm restoration and echocardiographic parameters.
- The procedure does not increase surgical morbidity or mortality.
- It also leads to a reduced need for postoperative anticoagulation.
Background:
The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain.
Methods And Results:
A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001).
Conclusions:
Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.
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