Surgical Atrial Fibrillation Ablation Improves Long-Term Survival: A Multicenter Analysis.

Area of Science:

• Cardiology
• Thoracic Surgery
• Cardiac Electrophysiology

Background:

• The Society of Thoracic Surgeons recommends surgical ablation (SA) for patients with atrial fibrillation (AF) undergoing cardiac surgery.
• Guidelines suggest SA during mitral operations, aortic valve replacement, coronary artery bypass grafting (CABG), and combined valve/CABG procedures.

Purpose of the Study:

• To assess the impact of concomitant SA on long-term survival in patients with AF undergoing cardiac surgery.
• To evaluate the association between SA and mortality and morbidity in a large patient cohort.

Main Methods:

• Retrospective analysis of 20,407 cardiac procedures (CABG or valve) from 2008-2015.
• Included 2,740 patients with preoperative AF, comparing those who received SA versus those who did not.
• Primary endpoint was all-cause mortality; secondary endpoints included in-hospital morbidity and mortality.

Main Results:

• Surgical ablation was performed in 23.1% of eligible patients, with increasing use over time.
• SA was associated with a substantial improvement in unadjusted survival (HR 0.54) and adjusted 5-year survival (HR 0.69).
• No significant differences in postoperative complications were observed; SA was linked to longer bypass times but shorter hospital stays.

Conclusions:

• Concomitant SA in patients with AF undergoing CABG, valve, or combined procedures leads to significantly improved long-term survival.
• Findings support and advocate for the broader implementation of SA as recommended by current surgical guidelines.