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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Long-Term Outcomes of Paroxysmal and Persistent Atrial Fibrillation Management Strategy During Nonemergent Coronary

Robert B Hawkins1, Boateng Kubi2, Raymond John Strobel3

  • 1Division of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.

The Annals of Thoracic Surgery
|May 14, 2026
PubMed

Insights

Management of atrial fibrillation (AF) during coronary artery bypass grafting (CABG) is crucial. Epicardial ablation demonstrated superior long-term survival, while all AF treatments reduced stroke risk in CABG patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Atrial fibrillation (AF) management during coronary artery bypass grafting (CABG) is a Class 1 recommendation.
  • This study investigates trends in AF treatment and their impact on long-term survival.
  • A significant proportion of AF patients undergoing CABG remain untreated.

Purpose of the Study:

  • To evaluate trends in AF management strategies during CABG.
  • To assess the association between different AF treatments and long-term patient survival.
  • To analyze the impact of AF management on secondary outcomes like stroke and pacemaker placement.

Main Methods:

  • Analysis of 59,331 patients with AF undergoing isolated CABG (2011-2022) from the STS Adult Cardiac Surgery Database linked to Medicare claims.
  • Stratification of patients based on AF treatment: none, left atrial appendage occlusion (LAAO) only, epicardial ablation (EA), or intracardiac ablation (IA).
  • Kaplan-Meier and Cox regression for mortality; competing-risk regression for nonfatal outcomes (stroke, pacemaker placement, readmissions).

Main Results:

  • AF treatment rates increased from 31.8% to 68.8%, largely driven by LAAO.
  • Persistent AF was associated with higher mortality than paroxysmal AF.
  • Epicardial ablation (EA) showed lower mortality than no treatment; all treatment groups had reduced stroke risk and AF readmissions.
  • Intracardiac ablation (IA) was linked to higher pacemaker implantation rates.

Conclusions:

  • Nearly half of AF patients undergoing CABG do not receive AF-specific treatment.
  • Epicardial ablation is associated with superior long-term survival post-CABG.
  • All evaluated AF management strategies, including LAAO and ablation, offer reduced stroke risk and AF readmissions.
Abstract

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