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. 2024 Mar 29;13(2):108-116.
doi: 10.21037/acs-2023-afm-17. Epub 2024 Feb 27.

The outcomes of concomitant catheter ablation in non-mitral valve cardiac surgery-a systematic review and meta-analysis of the literature

Ashley R Wilson-Smith  1   2   3   4   5   6   7 , Christian J Wilson-Smith  4 , Jemilla Strode Smith  4 , Dominic Ng  5 , Benjamin T Muston  2   4 , Aditya Eranki  2   5 , Michael L Williams  8 , Nathan Ussher  5 , Aashray K Gupta  9   10
Affiliations

The outcomes of concomitant catheter ablation in non-mitral valve cardiac surgery-a systematic review and meta-analysis of the literature

Ashley R Wilson-Smith et al. Ann Cardiothorac Surg. .

Abstract

Background: Atrial fibrillation (AF) is the most common form of cardiac arrythmia, with a key importance in the perioperative setting of cardiac surgery. In recent years, the question as to whether pre-existent AF should be treated concomitantly when undergoing cardiac surgery has been heatedly debated. This systematic review and meta-analysis sought to delineate the outcomes of patients undergoing concomitant AF ablation procedures alongside cardiac surgery.

Methods: The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 22 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously reported and validated techniques.

Results: A total of 9,428 patients (67% male) were identified across the study period as having received non-mitral cardiac surgery and concomitant AF ablation procedures. On actuarial assessment, freedom from AF was found to be 93%, 88%, 85%, 82%, and 79% at 1 through to 5 years, respectively. Freedom from mortality was found to be 94%, 93%, 91%, 90%, and 87% at 1 through to 5 years, respectively.

Conclusions: This review demonstrated excellent freedom from AF out to a long-term follow-up of 5 years. Freedom from mortality was also encouraging. Emerging data are increasingly illustrating that in this patient cohort, concurrent treatment of pre-existent AF with cardiac and/or valvular disease at the point of operation should be the standard of care. Robust data in the form of randomized control trials will hopefully solidify this assertion.

Keywords: Atrial fibrillation (AF); Cox-Maze; cardiac surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
All-comer freedom from AF from index procedure. AF, atrial fibrillation; CI, confidence interval.
Figure 2
Figure 2
All-comer freedom from mortality from index procedure. CI, confidence interval.
See this image and copyright information in PMC

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