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Multicenter Study
. 2025 Aug 2;67(8):ezaf244.
doi: 10.1093/ejcts/ezaf244.

Concomitant Surgical Ablation in Atrial Fibrillation Patients Undergoing Cardiac Surgery for Isolated Coronary and Aortic Valve Disease: A Multicentre Study from The Netherlands Heart Registration

M Agustina Bayón  1 , Miriam A Scheurwater  2 , Niels J Verberkmoes  2 , Massimo A Mariani  1 , Maaike M Roefs  3 , Job van der Palen  4 , Lukas R C Dekker  2 , Yuri Blaauw  1 , Thomas J van Brakel  2 ; Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration
Collaborators, Affiliations
Multicenter Study

Concomitant Surgical Ablation in Atrial Fibrillation Patients Undergoing Cardiac Surgery for Isolated Coronary and Aortic Valve Disease: A Multicentre Study from The Netherlands Heart Registration

M Agustina Bayón et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Concomitant surgical ablation (CSA) is recommended for atrial fibrillation (AF) patients undergoing cardiac surgery; however, its effects in non-mitral valve surgeries, specifically coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), are less studied. This study aims to analyse outcomes and trends of CSA performance in the Netherlands.

Methods: This nationwide multicentre study utilized data from the Netherlands Heart Registration. AF patients undergoing CABG or AVR between 2013 and 2021 were included. Temporal trends in CSA performance were analysed and a multivariable regression model adjusted for confounders when comparing CSA and non-CSA.

Results: A total of 3260 patients were included, of which 1081 underwent CSA. CSA patients showed longer cardiopulmonary bypass (CPB) (111 vs 80, mean difference between groups: 31 min [95% CI, 27-34, P < 0.001]) and aortic cross clamping (AoX) times (67 vs 52, mean difference: 15 min [95% CI, 13-17, P < 0.001]). After correcting for confounders, CSA patients presented mean CPB and AoX times of 18 (95% CI, 16-21, P < 0.001) and 8 (95% CI, 6-10, P < 0.001) min longer. The CSA group showed higher survival rates (92.5% vs 86.4%, P = 0.039) and greater improvements in mental quality of life (QoL) (P = 0.047). CSA performance during CABG and AVR has increased significantly, from 29.7% in 2018 to 44.4% in 2021.

Conclusions: CSA resulted in slightly longer CPB and AoX times but no significant differences in major complications. Regression analysis showed better survival rates and improved mental QoL for CSA. CSA performance in CABG and AVR has increased in the Netherlands.

Keywords: aortic valve replacement; atrial fibrillation; concomitant surgical ablation; coronary artery bypass grafting.

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Conflict of interest statement

None declared.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Kaplan-Meier Survival Analysis. Adjusted P-value for age, CPB use, renal impairment, LVEF <30%, PVD, DM, and EuroSCORE II. Abbreviation: CSA = concomitant surgical ablation
Figure 2.
Figure 2.
Comparison of Physical and Mental Health QoL Pre- and Postoperative. Abbreviations: BL: base line; CSA: concomitant surgical ablation; FU: follow-up; QoL: quality of life
Figure 3.
Figure 3.
Yearly Overview of CSA Performance, Showing the Percentage of Patients Who Received CSA. A significant increase in registered operations is observed from 2018 on, indicating underreporting of AF as preoperative characteristic and less accurate representation of the surgical trends before this year. Abbreviations: AVR: aortic valve replacement; CABG: coronary artery bypass grafting; SA: surgical ablation
See this image and copyright information in PMC

References

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