Related Experiment Video
Updated: Jul 8, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Concomitant Treatment of Atrial Fibrillation in Isolated Coronary Artery Bypass Grafting
J Hunter Mehaffey1, J W Awori Hayanga1, Lawrence M Wei1
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
Insights
Concomitant management of atrial fibrillation (AF) during cardiac surgery, including surgical ablation (SA) and left atrial appendage obliteration (LAAO), reduced stroke readmissions. SA + LAAO improved survival and reduced stroke or death compared to no AF treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is common in patients undergoing cardiac surgery.
- Guidelines recommend managing AF during procedures like coronary artery bypass grafting (CABG).
- Real-world data on AF management strategies during CABG is limited.
Purpose of the Study:
- To evaluate the adoption and outcomes of concomitant AF management in Medicare beneficiaries undergoing isolated CABG.
- To compare the effectiveness of surgical ablation (SA) and left atrial appendage obliteration (LAAO), alone or in combination (SA + LAAO), versus no AF treatment.
Main Methods:
- Retrospective analysis of Medicare inpatient claims data (2018-2020).
- Identified patients with AF undergoing isolated CABG.
- Used doubly robust risk adjustment for comparative analysis of outcomes.
Main Results:
- 19,524 patients with AF undergoing isolated CABG were analyzed.
- Concomitant AF treatment (SA + LAAO or LAAO alone) significantly reduced 3-year stroke readmission compared to no AF treatment.
- SA + LAAO improved 3-year survival and composite outcomes (freedom from stroke or death) compared to LAAO alone or no AF treatment.
Conclusions:
- Concomitant AF management during isolated CABG in Medicare beneficiaries is associated with reduced stroke readmissions.
- Surgical ablation combined with left atrial appendage obliteration (SA + LAAO) offers superior outcomes regarding survival and composite stroke or death events at 3 years.
Background:
Societal guidelines support concomitant management of atrial fibrillation (AF) in patients undergoing cardiac surgery. To assess real-world adoption and outcomes, this study evaluated Medicare beneficiaries with AF who underwent isolated coronary artery bypass grafting (CABG) with surgical ablation (SA) or left atrial appendage obliteration (LAAO) or both procedures in combination (SA + LAAO).
Methods:
The US Centers for Medicare & Medicaid Services inpatient claims database identified all patients with AF who underwent isolated CABG from 2018 to 2020. Diagnosis-related group and International Classification of Diseases-10th revision procedure codes defined covariates for doubly robust risk adjustment.
Results:
A total of 19,524 patients with preoperative AF who underwent isolated CABG were stratified by SA + LAAO (3475 patients; 17.8%), LAAO only (4541 patients; 23.3%), or no AF treatment (11,508 patients; 58.9%). After doubly robust risk adjustment, longitudinal analysis highlighted that concomitant AF treatment with SA + LAAO (hazard ratio [HR], 0.74; P = .049) or LAAO alone (HR, 0.75; P = . 031) was associated with a significant reduction in readmission for stroke at 3 years compared with no AF treatment. Furthermore, SA + LAAO (HR, 0.86; P = .016) but not LAAO alone (HR, 0.97; P = .573) was associated with improved survival compared with no AF treatment. Finally, SA + LAAO was associated with a superior composite outcome of freedom from stroke or death at 3 years compared with LAAO alone (HR, 0.86;, P = .033) or no AF treatment (HR, 0.81; P = .001).
Conclusions:
In Medicare beneficiaries with AF who underwent isolated CABG, concomitant AF treatment was associated with reduced 3-year readmission for stroke. SA + LAAO was associated with superior reduction in stroke or death at 3 years compared with LAAO alone or no AF treatment.
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