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Long-term Outcomes of Concomitant Surgical Ablation for Atrial Fibrillation
Yu-Ting Cheng1, Yu-Tung Huang2, Hui-Tzu Tu2
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Insights
Surgical ablation for atrial fibrillation (AF) during cardiac surgery improves long-term survival and reduces stroke risk. This procedure is safe and beneficial for patients undergoing heart surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Long-term outcomes of surgical ablation for atrial fibrillation (AF) during cardiac surgery are not well-established.
- Atrial fibrillation is a common arrhythmia often managed surgically in conjunction with other cardiac procedures.
Purpose of the Study:
- To evaluate the long-term survival and ischemic stroke risk in patients undergoing cardiac surgery with concomitant AF ablation.
- To compare outcomes between patients who received surgical ablation for AF and those who did not.
Main Methods:
- A nationwide, population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database.
- Included 11,459 patients undergoing coronary artery bypass graft, valve, or aortic surgery with AF diagnosis (2001-2016).
- Propensity score matching was used to minimize selection bias and compare outcomes.
Main Results:
- Surgical ablation significantly reduced all-cause mortality (HR, 0.75) and ischemic stroke risk post-discharge (SHR, 0.78).
- Concomitant AF ablation with specific cardiac surgeries (CABG, TVAR, TMVR, MVR) led to significantly better long-term survival.
- Patients with surgical ablation showed improved long-term survival compared to a matched general AF population.
Conclusions:
- Concomitant AF ablation during cardiac surgery is safe and does not increase perioperative complications.
- Surgical ablation for AF in cardiac surgery patients confers significant long-term survival benefits.
- AF ablation improves long-term survival in cardiac surgery patients compared to the general AF population.
Background:
The long-term outcomes of surgical ablation for atrial fibrillation (AF) during cardiac surgery remain unclear.
Methods:
This nationwide population-based retrospective cohort study used data from Taiwan's National Health Insurance Research Database. Overall, 11,459 patients undergoing coronary artery bypass graft, valve, or aortic surgery and diagnosed as having AF between January 1, 2001, and December 31, 2016, were included. To reduce possible selection bias, we created a propensity score-matched cohort and compared outcomes between groups. The outcomes of interest were long-term survival and late ischemic stroke.
Results:
The surgical ablation group had a significantly lower risk of all-cause mortality (5.74 and 7.69 events per 100 patient-years, respectively; hazard ratio, 0.75; 95% CI, 0.69-0.81) and ischemic stroke after discharge (1.88 and 2.52 events per 100 patient-years, respectively; subdistribution hazard ratio, 0.78; 95% CI, 0.67-0.91). AF ablation performed concomitantly with coronary artery bypass graft surgery, tissue aortic valve replacement, tissue mitral valve replacement, or mitral valve repair led to significantly better long-term survival (P = .0176, P = .0001, P < .0001, P < .0001, respectively). The surgical ablation group also had better long-term survival than the matched general AF population (log-rank test, P < .001).
Conclusions:
Concomitant AF ablation during cardiac surgery is safe, does not increase the rate of perioperative complications, and confers the benefit of long-term survival after cardiac surgery in adults. AF ablation also improved cardiac surgery patients' long-term survival compared with the matched general AF population.
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