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Concomitant Surgical Ablation in Atrial Fibrillation Patients Undergoing Cardiac Surgery for Isolated Coronary and
M Agustina Bayon1, Miriam A Scheurwater2, Niels J Verberkmoes2
1Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen 9713GZ, The Netherlands.
Insights
Concomitant surgical ablation (CSA) for atrial fibrillation during coronary artery bypass grafting and aortic valve replacement slightly increases procedure times but improves survival and mental quality of life. CSA use in these procedures is rising in the Netherlands.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Concomitant surgical ablation (CSA) is recommended for atrial fibrillation (AF) patients undergoing cardiac surgery.
- Its efficacy in non-mitral valve surgeries like coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) requires further investigation.
Purpose of the Study:
- To analyze the outcomes and trends of CSA performance in patients undergoing CABG or AVR in the Netherlands.
- To evaluate the impact of CSA on procedural times, survival rates, and quality of life.
Main Methods:
- Nationwide multicenter study using data from the Netherlands Heart Registration (2013-2021).
- Inclusion of AF patients undergoing CABG or AVR.
- Analysis of temporal trends in CSA performance and multivariable regression to compare CSA and non-CSA groups.
Main Results:
- CSA was performed in 1081 out of 3260 patients.
- CSA was associated with longer cardiopulmonary bypass (CPB) and aortic cross-clamping (AoX) times, even after adjustment for confounders.
- CSA patients demonstrated significantly higher survival rates (92.5% vs 86.4%) and improved mental quality of life.
Conclusions:
- CSA in CABG and AVR leads to slightly prolonged CPB and AoX times but does not significantly increase major complications.
- CSA is associated with improved survival and mental quality of life.
- The adoption of CSA for CABG and AVR procedures has notably increased in the Netherlands between 2018 and 2021.
Objectives:
Concomitant surgical ablation (CSA) is recommended for atrial fibrillation (AF) patients undergoing cardiac surgery; however, its effects in non-mitral valve surgeries, specifically coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), are less studied. This study aims to analyse outcomes and trends of CSA performance in the Netherlands.
Methods:
This nationwide multicentre study utilized data from the Netherlands Heart Registration. AF patients undergoing CABG or AVR between 2013 and 2021 were included. Temporal trends in CSA performance were analysed and a multivariable regression model adjusted for confounders when comparing CSA and non-CSA.
Results:
A total of 3260 patients were included, of which 1081 underwent CSA. CSA patients showed longer cardiopulmonary bypass (CPB) (111 vs 80, mean difference between groups: 31 min [95% CI, 27-34, P < 0.001]) and aortic cross clamping (AoX) times (67 vs 52, mean difference: 15 min [95% CI, 13-17, P < 0.001]). After correcting for confounders, CSA patients presented mean CPB and AoX times of 18 (95% CI, 16-21, P < 0.001) and 8 (95% CI, 6-10, P < 0.001) min longer. The CSA group showed higher survival rates (92.5% vs 86.4%, P = 0.039) and greater improvements in mental quality of life (QoL) (P = 0.047). CSA performance during CABG and AVR has increased significantly, from 29.7% in 2018 to 44.4% in 2021.
Conclusions:
CSA resulted in slightly longer CPB and AoX times but no significant differences in major complications. Regression analysis showed better survival rates and improved mental QoL for CSA. CSA performance in CABG and AVR has increased in the Netherlands.
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