Statewide data on surgical ablation for atrial fibrillation: The data provide a path forward

Area of Science:

• Cardiovascular Surgery
• Cardiac Electrophysiology
• Health Services Research

Background:

• Atrial fibrillation (AF) significantly increases morbidity and mortality if untreated.
• Standardization of surgical ablation (SA) for AF, including patient selection and lesion sets, is lacking.
• Multi-society guidelines support surgical intervention for AF.

Purpose of the Study:

• To analyze a statewide cardiac surgery registry to determine the association between center volume and index procedure type with the performance of SA for AF.
• To examine the variability in lesion sets and ablation technologies used for SA.
• To identify discrepancies between evidence-based guidelines and real-world SA practices.

Main Methods:

• Analysis of adult, first-time, non-emergency patients with preoperative AF (2014-2022) from the Society of Thoracic Surgeons registry (N=4320).
• Exclusion of standalone SA procedures.
• Examination of AF treatment variability by hospital volume and surgery type using chi-squared analyses and Spearman correlations.

Main Results:

• Surgical ablation (SA) was performed in 37% of AF patients, with higher rates during mitral procedures (63%) compared to non-mitral procedures (26%).
• A significant temporal trend showed increasing SA performance over time (P < .001).
• Hospital cardiac surgery volume and academic status did not correlate with SA rates; procedure type was the most consistent factor influencing SA decisions.

Conclusions:

• Adoption of SA for AF has increased, but performance is not associated with hospital volume or academic status.
• The type of index cardiac procedure, particularly mitral surgery, strongly influences the decision to perform SA, irrespective of AF pathophysiology.
• A significant gap exists between evidence-based guidelines and current clinical practice, indicating opportunities to extend SA benefits to more patients.