Surgical atrial fibrillation ablation improves long-term survival: A multicenter analysis.

BACKGROUND: Society of Thoracic Surgeons guidelines recommend surgical ablation (SA) at the time of concomitant mitral operations, aortic valve replacement, coronary artery bypass grafting (CABG), and AVR plus CABG for patients in atrial fibrillation (AF). The goal of this analysis was to assess the influence of SA on long term survival.

METHODS: A retrospective analysis of 20,407 consecutive CABG or valve procedures from 2008-2015 among 7 centers reporting to a prospectively maintained clinical registry was conducted. Patients undergoing surgery with documented pre-operative AF were included (n=2,740). Patients receiving SA were compared to those receiving no SA. The primary endpoint was all-cause mortality. Secondary endpoints included in-hospital morbidity and mortality.

RESULTS: The frequency of SA was 23.1% (n=634), and there was an increase in the rate of SA over the study period (p<0.001). Concomitant SA was performed in: 16.2% of CABG, 30.6% of valve, and 24.3% of valve plus CABG cases. There was a significant improvement in unadjusted survival among patients undergoing SA (HR 0.54, 95%CI=0.42-0.70). Moreover, there were no differences in post-operative complications. SA patients did have longer bypass times (p<0.001) but a shorter overall length of stay (p<0.001). After risk adjustment, SA patients had an improved 5-year survival (HR 0.69, 95%CI=0.51-0.92), and the effect was observed across all operations.

CONCLUSIONS: In a multi-center cohort of patients with AF, concomitant SA resulted in significantly improved long-term survival across CABG, valve, and valve plus CABG patients. These findings support current STS guidelines recommending broader application of concomitant SA.