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Updated: Sep 1, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial fibrillation ablation improves late survival after concomitant cardiac surgery
Mariusz Kowalewski1, Michał Pasierski2, Michalina Kołodziejczak3
1Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
Insights
Surgical ablation (SA) for atrial fibrillation (AF) during heart surgery significantly reduces long-term mortality. This survival benefit was observed even in patients with higher baseline surgical risk, highlighting SA
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Preoperative atrial fibrillation (AF) is a known risk factor for adverse outcomes post-cardiac surgery, including stroke, heart failure, and mortality.
- Despite guideline recommendations, the utilization of surgical ablation (SA) for concomitant AF during cardiac surgery remains suboptimal.
Purpose of the Study:
- To evaluate the long-term mortality rates associated with surgical ablation (SA) performed concurrently with other cardiac surgical procedures.
- To determine if SA improves survival outcomes in patients with preoperative atrial fibrillation undergoing cardiac surgery.
Main Methods:
- The study utilized data from the HEart surgery In atrial fibrillation and Supraventricular Tachycardia (HEIST) registry, encompassing 20,765 adult patients with preoperative AF undergoing conventional sternotomy between 2010 and 2021.
- Cox proportional hazards models and propensity score matching were employed to analyze long-term mortality and minimize baseline characteristic differences between patients who did and did not undergo SA.
Main Results:
- A total of 2755 patients (13.4%) underwent SA. SA was more common in mitral interventions (25.2%) and less common in isolated coronary artery bypass grafting (6.2%).
- Patients undergoing SA were younger and had a lower predicted surgical risk (EuroSCORE II).
- Unadjusted analysis showed a significant mortality reduction with SA (HR, 0.57). After propensity score matching, SA was associated with a 16% reduction in mortality (HR, 0.84; P = .003).
Conclusions:
- Surgical ablation (SA) performed concomitantly with other cardiac surgeries is associated with improved long-term survival.
- The survival benefit of SA was evident across different baseline surgical risk strata.
- These findings support the consideration of SA in eligible patients with AF undergoing cardiac surgery.
Objective:
Preoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant with other heart surgery remains low. In the current study we aimed to address the long-term mortality after SA concomitant with cardiac surgery.
Methods:
This report pertains to the HEart surgery In atrial fibrillation and Supraventricular Tachycardia (HEIST) registry. We identified 20,765 adult patients (62% male) with preoperative AF who underwent conventional sternotomy heart surgery between 2010 and 2021 in 8 tertiary centers in Poland, Netherlands, and Italy. We used Cox proportional hazards models for computations and propensity score matching to minimize differences in baseline characteristics.
Results:
Of included patients, 2755 (13.4%) underwent SA for AF. The highest rates of SA were observed for mitral interventions (mitral valve repair or replacement and tricuspid intervention, 25.2%), lowest for isolated coronary artery bypass grafting (6.2%). Patients in the SA group were younger (mean age 64.5 ± 9.0 years vs 68.7 ± 16.0 years; P < .001) and lower risk (mean European System for Cardiac Operative Risk Evaluation [EuroSCORE] II, 4.1 vs 5.7; P < .001). During the 11-year study period, there was a mortality reduction associated with SA (hazard ratio, 0.57; 95% CI, 0.52-0.62; P < .001). After propensity matching, 2750 pairs with similar baseline characteristics were identified. SA was associated with 16% mortality decline (hazard ratio, 0.84; 95% CI, 0.75-0.94; P = .003).
Conclusions:
In this multicenter, retrospective, propensity matched study, SA concomitant with other cardiac surgery was associated with improved long-term survival regardless of baseline surgical risk.
