Surgical Ablation for Treatment of Atrial Fibrillation in Cardiac Surgery: A Cumulative Meta-Analysis of Randomised Controlled Trials

Study Questions:

What are the outcomes of concomitant surgical ablation (SA) of atrial fibrillation (AF) in patients undergoing cardiac surgery?


This was a meta-analysis of 16 randomized studies that compared concomitant SA with no SA in a total of 1,082 patients with AF undergoing cardiac surgery. SA consisted of radiofrequency ablation in seven studies, the Cox-maze procedure in four, cryoablation in three, and microwave ablation in two.


There was not a significant difference in 30-day mortality between the SA (5.3%) and no SA (3.8%) groups. Strokes were reported in a similar proportion of patients undergoing SA (4.9%) and no SA (5.8%). The pacemaker implantation rate also was similar in the two groups (5.8% vs. 8.3% in the SA and no SA groups, respectively). A significantly higher proportion of patients were in sinus rhythm at 6 months (62.6% vs. 27.4%) and ≥1 year (66.7% vs. 26.1%) after SA than after cardiac surgery without SA.


The authors concluded that concomitant SA for AF is safe and effective in patients undergoing cardiac surgery.


This meta-analysis demonstrates that concomitant SA does not increase the risk of complications associated with cardiac surgery. However, it is very likely that the true efficacy of SA was lower than reported in the meta-analysis. This is because several of the studies based efficacy on the absence of AF during 3-4 clinic visits and one or two 24-hour Holter monitor recordings during 12 months of follow-up. This minimal degree of rhythm surveillance is inadequate for accurate assessment of efficacy after any type of AF ablation procedure.

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