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. 2023 Oct 20:16:333-341.
doi: 10.1016/j.xjon.2023.10.013. eCollection 2023 Dec.

Trends in surgical ablation at the time of cardiac surgery among patients with atrial fibrillation

Haley N Jenkins  1 , Aaron J Weiss  1 , Jean-Luc A Maigrot  1 , Guangjin Zhou  2 , Siran M Koroukian  2 , A Marc Gillinov  1 , Lars Svensson  1 , Edward G Soltesz  1
Affiliations

Trends in surgical ablation at the time of cardiac surgery among patients with atrial fibrillation

Haley N Jenkins et al. JTCVS Open. .

Abstract

Background: The 2017 American Association for Thoracic Surgery (AATS) guidelines support surgical ablation in patients undergoing cardiac surgery with preoperative atrial fibrillation (AF) owing to a reduction in early mortality and improved overall safety. We explored practice patterns changes and outcomes in patients undergoing concomitant surgical ablation following the guideline change.

Methods: We identified 19,246 patients with preoperative AF who underwent cardiac surgery between 2016 and 2019 from the Florida and Maryland State Inpatient Databases. Rates of surgical ablation by procedure type were temporally trended across years. Secondary outcomes included complications, inpatient mortality, and hospital readmissions. Using multivariable logistic regression, we identified patient variables associated with concomitant surgical ablation.

Results: A total of 2738 patients (14.3%) with AF underwent a concomitant surgical ablation. The rate of surgical ablation increased from 2.1% to 17.4% (P < .001) from 2016 to 2017 but remained unchanged thereafter. Postoperative mortality was lower in the surgical ablation cohort (2.7% vs 3.7%; P = .006), although with a higher rate of pacemaker insertion (11.8% vs 7.2%; P < .0001). Patients with a high-risk Elixhauser score (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.73-0.95), lower income (OR, 0.66; 95% CI, 0.57-0.75), or African American or Hispanic race/ethnicity (OR, 0.80; 95% CI, 0.67-0.96 and OR, 0.82; 95% CI, 0.71-0.96, respectively) had lower odds of undergoing concomitant surgical ablation.

Conclusions: Despite a class I-2a recommendation by the AATS, surgical ablation continues to be underutilized in clinical practice, especially in patients with high-risk comorbidities, with lower incomes, or from minority populations. Surgeons should be mindful of guideline-directed AF management in these vulnerable populations.

Keywords: Maze procedure; atrial fibrillation; surgical ablation.

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Conflict of interest statement

Dr Soltesz has been a consultant for Abiomed, Atricure, and Abbott. Dr Gillinov serves as a consultant for AtriCure, Medtronic, Edwards Lifesciences, Abbott, CryoLife, and ClearFlow. The other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Rates of concomitant surgical ablation in patients with atrial fibrillation by year.
Figure 1
Figure 1
Temporal trend in rates of concomitant surgical ablation among patients with preoperative atrial fibrillation from January 2016 to December 2019. The vertical black line represents the 2017 guideline changes. CABG, Coronary artery bypass grafting; MVr/R, mitral valve repair/replacement; AVr/R, aortic valve repair/replacement.
Figure 2
Figure 2
Forest plot demonstrating the odds ratio (OR) and 95% confidence interval (CI) of receiving a surgical ablation given each preoperative factor.
See this image and copyright information in PMC

References

    1. Ad N., Suri R.M., Gammie J.S., Sheng S., O'Brien S.M., Henry L. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg Open. 2012;144:1051–1060. - PubMed
    1. Iwasaki Y.K., Nishida K., Kato T., Nattel S. Atrial fibrillation pathophysiology: implications for management. Circulation. 2011;124:2264–2274. - PubMed
    1. McClure G.R., Belley-Cote E.P., Singal R.K., Jaffer I.H., Dvirnik N., An K.R., et al. Surgical ablation of atrial fibrillation: a protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2016;6 - PMC - PubMed
    1. Andrade J., Khairy P., Dobrev D., Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114:1453–1468. - PubMed
    1. Alberts M., Chen Y.W., Lin J.H., Kogan E., Twyman K., Milentijevic D. Risks of stroke and mortality in atrial fibrillation patients treated with rivaroxaban and warfarin. Stroke. 2020;51:549–555. - PMC - PubMed

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