Should Paroxysmal Atrial Fibrillation Be Treated During Cardiac Surgery?

Oct 04, 2013
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Authors:
McCarthy PM, Manjunath A, Kruse J, et al.
Citation:
J Thorac Cardiovasc Surg 2013;146:810-823.
Summary By:
Fred Morady, MD, FACC

Study Questions:

How does concomitant surgical ablation of paroxysmal atrial fibrillation (AF) affect outcomes after cardiac surgery?

Methods:

In this retrospective single-center study, propensity matching was used to compare 3,797 patients without AF (mean age 61.7 years) who underwent cardiac surgery, 423 patients (mean age 66.5 years) with paroxysmal AF who underwent surgical AF ablation at the time of cardiac surgery, and 129 patients (mean age 68.7 years) with paroxysmal AF that was not treated during cardiac surgery. One of four lesion sets was used for surgical ablation, at the operator’s discretion. Assessment of AF ablation efficacy during a mean follow-up of 2.8 years was based on periodic clinical evaluation and ambulatory monitoring whenever available.

Results:

The 30-day mortality rate was similar in the three groups of patients. Among the patients with paroxysmal AF, the patients who underwent concomitant ablation had a lower perioperative complication rate (26% vs. 46%), higher freedom from AF (81% vs. 60%), and 47% lower mortality than untreated patients with AF. Compared to the patients without a history of AF, the patients who underwent concomitant AF ablation had a lower perioperative complication rate (25% vs. 48%), lower freedom from AF (84% vs. 93%), and similar mortality.

Conclusions:

The authors concluded that concomitant treatment for paroxysmal AF does not increase the risk of cardiac surgery, and results in freedom from AF in approximately 80% of patients.

Perspective:

In a nationwide cardiac surgery database published in 2008, <50% of patients with AF underwent concomitant surgical AF ablation during a cardiac operation. The authors of this study concluded that concomitant surgical ablation of paroxysmal AF should be utilized more often because of its favorable risk:benefit ratio.

Keywords: Follow-Up Studies, Pulmonary Veins, Risk Assessment, Cardiac Surgical Procedures, Catheter Ablation, Tachycardia


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