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Surgical Ablation for Atrial Fibrillation: Risk Factors for Recurrence and Long-Term Outcome
Jonathan Frogel1, Alexander Kogan2, John G Augoustides3
1Department of Anesthesiology, Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Surgical ablation for atrial fibrillation (AF) demonstrates high long-term success rates, with significant freedom from arrhythmia up to 7 years. Age and female sex were identified as key factors influencing AF recurrence.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with limited drug efficacy.
- Interventional treatments like catheter and surgical ablation are increasingly explored.
- Surgical ablation, or the maze procedure, is an option for patients undergoing cardiac surgery.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of surgical ablation for AF.
- To identify risk factors for arrhythmia recurrence and mortality after surgical AF ablation.
Main Methods:
- Retrospective analysis of prospectively collected data from 668 patients.
- Surgical AF ablation performed between January 2006 and June 2022.
- Follow-up assessments at 1, 3, 5, and 7 years for arrhythmia recurrence and mortality.
Main Results:
- High freedom from AF at 1 year (97.6%), 3 years (95.3%), 5 years (90.1%), and 7 years (77.5%).
- Mortality rates at 1, 3, 5, and 7 years were 3%, 6.1%, 9.1%, and 10.8%, respectively.
- Age and female sex predicted 7-year AF recurrence; diabetes, age, and valve surgery predicted 7-year mortality.
Conclusions:
- Surgical ablation offers a high success rate for treating atrial fibrillation.
- Long-term follow-up confirms sustained freedom from atrial arrhythmia.
- Predictive factors for recurrence and mortality were identified, aiding risk stratification.
Objectives:
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Due to the insufficient efficacy of antiarrhythmic drugs and their adverse side effects, there has been considerable interest in the interventional treatment of AF, including both catheter ablation and surgical ablation. Surgical ablation or the maze procedure is a treatment option for patients with AF undergoing concomitant or isolated cardiac surgery.
Design:
We performed a retrospective study of prospectively collected data to investigate short- and long-term outcomes of patients who underwent the surgical ablation of AF. Outcome variables included freedom from recurrent atrial arrhythmias and mortality at 1-, 3-, 5-, and 7-year follow-ups. We also identified risk factors for arrhythmia recurrence and mortality.
Setting:
Israel's largest university tertiary care center.
Participants:
The study population comprised 668 patients operated on between January 1, 2006, and June 30, 2022. All patient data were extracted from our departmental database.
Interventions:
Concomitant or stand-alone surgical AF ablation.
Measurements And Main Results:
The mean duration of follow-up was 106 ± 66.7 months. Freedom from AF was 97.6% (n = 615) and mortality was 3% (n = 20) at the 1-year follow-up, 95.3% (n = 574) and 6.1% (n = 45) at 3 years, 90.1% (n = 396) and 9.1% (n = 61) at 5 years, and 77.5% (n = 308) and 10.8% (n = 72) at 7 years. According to logistic regression analysis, age and female sex determined the 7-year freedom from AF, and risk factors for 7-year mortality included diabetes mellitus, age, and valve surgery.
Conclusions:
Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1-, 3-, 5-, and 7-year follow-ups. Age and female sex were factors determining the 5- and 7-year recurrence of AF.
