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Concomitant atrial fibrillation ablation in patients undergoing coronary artery bypass and cardiac valve surgery

Andrei Churyla1, Anand Desai1, Jane Kruse1

  • 1Division of Cardiac Surgery, Department of Surgery, Northwestern Medicine Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois.

Journal of Cardiovascular Electrophysiology
|February 26, 2020
PubMed

Insights

Surgical ablation of atrial fibrillation (AF) during other heart surgeries is recommended. This procedure improves quality of life, reduces stroke risk, and enhances long-term survival, though underutilized.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Surgical ablation of atrial fibrillation (AF) alongside other cardiac procedures is a Class I guideline recommendation.
  • Concomitant AF ablation during valve surgery and coronary artery bypass grafting (CABG) is safe and effective, promoting sinus rhythm and improving outcomes.
  • Underutilization of AF ablation during CABG and aortic valve surgery persists despite evidence.

Purpose of the Study:

  • To update the electrophysiology and surgical communities on recommended surgical techniques for AF ablation.
  • To review the effects of concomitant AF ablation on perioperative outcomes, stroke, quality of life, and survival.

Main Methods:

  • Review of existing literature and observational studies on concomitant AF ablation during cardiac surgery.
  • Analysis of data regarding perioperative morbidity, mortality, long-term stroke risk, quality of life, and survival.
  • Inclusion of left atrial appendage closure as a component of surgical AF ablation.

Main Results:

  • Large observational studies show improved quality of life, reduced long-term strokes, and enhanced late survival in patients undergoing AF ablation.
  • Left atrial appendage closure significantly reduces long-term stroke risk and improves AF treatment success.
  • The survival benefit of concomitant AF ablation has not been fully addressed by major guideline committees.

Conclusions:

  • Concomitant surgical ablation of AF during other cardiac surgeries offers significant long-term benefits, including improved survival and reduced stroke risk.
  • Recommended surgical techniques and the importance of left atrial appendage closure are highlighted.
  • Increased adoption of AF ablation during cardiac surgery is warranted to improve patient outcomes.

Keywords:
atrial fibrillationleft atrial appendagemaze proceduresurgical ablation

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