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Surgical ablation for atrial fibrillation during isolated coronary artery bypass surgery
Piotr Suwalski1, Mariusz Kowalewski1,2,3, Marek Jasiński4
1Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland.
Insights
Surgical ablation for atrial fibrillation (AF) during coronary artery bypass grafting (CABG) is safe. This procedure significantly improves long-term survival rates in patients undergoing CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Research
Background:
- Atrial fibrillation (AF) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG).
- The efficacy of concomitant surgical ablation for AF during isolated CABG on early outcomes and long-term survival requires evaluation.
Purpose of the Study:
- To assess early sequelae and long-term survival in patients undergoing isolated CABG with concomitant surgical ablation for AF.
- To compare outcomes between isolated CABG with ablation versus isolated CABG alone.
Main Methods:
- Analysis of procedural data from the Polish National Registry of Cardiac Surgery Procedures (KROK) between 2006 and 2018.
- Inclusion of 7879 patients with AF undergoing isolated CABG.
- Propensity score matching and Cox proportional hazards models to compare outcomes between isolated CABG + ablation and isolated CABG groups.
Main Results:
- Surgical ablation (346 patients) was associated with a lower 30-day risk of death (RR 0.37) and multiorgan failure (RR 0.29).
- Long-term follow-up revealed a significant 33% improvement in overall survival for patients who underwent ablation (HR 0.67).
- Benefits were most pronounced in specific subgroups, including older patients, those with 3-vessel disease, prior cerebrovascular accident, preserved left ventricular function, and those undergoing on-pump CABG.
Conclusions:
- Concomitant surgical ablation for AF during isolated CABG is a safe procedure.
- This combined approach is associated with significantly improved long-term survival rates.
Objectives:
Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF).
Methods:
Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7-7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG.
Results:
Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolated CABG + ablation vs 918 of isolated CABG alone), surgical ablation was associated with a lower 30-day risk of death [risk ratio 0.37, 95% confidence interval (CI) 0.15-0.91; P = 0.032] and multiorgan failure (risk ratio 0.29, 95% CI 0.10-0.94; P = 0.029). In the long term, surgical ablation was associated with a significant 33% improved overall survival rate: hazard ratio 0.67, 95% CI 0.49-0.90; P = 0.008. The benefit of ablation was sustained in the subgroups but was most pronounced in lower risk older patients (age >70 years, P = 0.020; elective status, P = 0.011) with 3-vessel disease (P = 0.036), history of a cerebrovascular accident (P = 0.018) and preserved left ventricular function [left ventricular ejection fraction >50%; P = 0.017; no signs of heart failure (per New York Heart Association functional class); P = 0.001] and those undergoing on-pump CABG (P < 0.001).
Conclusion:
Surgical ablation for AF in patients undergoing isolated CABG is safe and associated with significantly improved long-term survival.
