Non-Atriotomy Surgical Ablation Is Associated With a Reduction of Postoperative Atrial Fibrillation

Postoperative atrial fibrillation (POAF) is common after cardiac operations, and effective intraoperative techniques aimed at reducing POAF focus on limiting left atrial triggers through posterior pericardiotomy or pulmonary vein isolation. Prophylactic left atrial appendage occlusion (LAAO) is increasingly used in hopes of preventing POAF-associated strokes. We sought to compare the incidence of POAF in patients undergoing prophylactic LAAO with or without a prophylactic non-atriotomy surgical ablation (NASA).

A retrospective observational cohort comparison study of patients undergoing first-time isolated coronary artery bypass grafting (CABG) with LAAO only (n = 90) or NASA+LAAO (n = 42) was conducted from July 2020 through November 2022. In-hospital POAF was defined by standard Society of Thoracic Surgeons (STS) definitions using 24-hour continuous telemetry and daily electrograms. Standard STS outcomes were also examined. Data are represented as mean ± SD. P values <.05 are considered significant.

STS-collected patient demographics, operative characteristics, and major complications did not differ significantly between cohorts. The rate of POAF (LAAO only, 41.1%; NASA+LAAO, 4.7%; P < .0001; odds ratio, 0.07; 95% CI, 0.016-0.27) and amiodarone on discharge (LAAO only, 42.5%; NASA+LAAO, 7.3%; P < .0001; odds ratio, 0.11; 95% CI, 0.03-0.33) differed significantly between cohorts. Total hospital costs were similar.

In patients with isolated coronary artery bypass grafting undergoing LAAO, a NASA is associated with a reduction of in-hospital POAF and need for antiarrhythmic medications on discharge. Future randomized prospective controlled studies are needed to prove safety and effectiveness.