Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Area of Science:

• Cardiovascular Surgery
• Electrophysiology
• Cardiac Arrhythmias

Background:

• Surgical atrial ablation is a procedure evaluated based on estimated surgical risk.
• The study investigates whether high-risk patients (HRPs) experience increased risk following ablation procedures.

Purpose of the Study:

• To analyze the 1-year outcomes of atrial ablation in high-risk patients compared to low-risk patients.
• To determine if ablation procedures escalate risks in patients with pre-existing comorbidities.

Main Methods:

• Analysis of the prospective, multicenter CASE-Atrial Fibrillation (AF) registry.
• Inclusion of 1,000 consecutive patients undergoing atrial ablation in cardiac surgery.
• Patient stratification based on EuroSCORE II (≤2 vs. >2) to define HRPs and LRPs.

Main Results:

• HRPs had higher rates of comorbidities (e.g., heart failure, stroke history, renal insufficiency, COPD, diabetes) and lower ejection fraction.
• Despite increased complexity (e.g., combination surgeries, CABG, mitral valve procedures), mortality and stroke rates in HRPs did not exceed their baseline risk.
• Similar rates of freedom from AF and symptom relief were observed between HRPs and LRPs, with lower long-term symptoms in HRPs.

Conclusions:

• Underlying disease, not ablation, determines long-term mortality in HRPs.
• Atrial ablation is effective in achieving freedom from AF and symptom relief in HRPs.
• Preoperative risk scores should not preclude HRPs from undergoing ablation procedures.