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. 2025 Jun 20:26:52-60.
doi: 10.1016/j.xjon.2025.06.007. eCollection 2025 Aug.

Concomitant atrial fibrillation ablation during aortic valve and aneurysm surgery

Eric Robinson  1 , Tom Liu  1 , S Chris Malaisrie  1 , Jane Kruse  1 , Beth Whippo  1 , Seokyung An  1 , Abigail S Baldridge  1 , Douglas R Johnston  1 , James L Cox  1 , Patrick M McCarthy  1 , Duc T Pham  1 , Christopher K Mehta  1
Affiliations

Concomitant atrial fibrillation ablation during aortic valve and aneurysm surgery

Eric Robinson et al. JTCVS Open. .

Abstract

Objective: Limited data are available on treatment of atrial fibrillation during ascending aortic aneurysm and aortic valve surgery. Ablation at the time of isolated aortic valve surgery has a Society of Thoracic Surgeons Class I indication. We sought to determine early and late outcomes of concomitant atrial fibrillation surgery at the time of ascending aortic aneurysm + aortic valve surgery.

Methods: From July 2008 to June 2023, patients undergoing elective ascending aortic aneurysm + aortic valve surgery ± atrial fibrillation surgery were compared. Clinical follow-up was conducted annually (median 5.6 [3.1-9.2] years).

Results: Of 792 patients in the cohort, 89 (11.2%) had preoperative atrial fibrillation and all underwent atrial fibrillation ablation procedures: pulmonary vein isolation (42.7%), left atrial cryoablation (19.1%), and biatrial cryoablation (38.2%). After 2:1 propensity score matching between the no atrial fibrillation (123) and ablation groups (67), postoperative complications were pacemaker implant (1.7% vs 1.6%; P = .952), new-onset dialysis (0.8% vs 3.0%, P = .251), and 30-day mortality (0.8% vs 1.5%, P = .661). In matched patients with no atrial fibrillation and atrial fibrillation surgery, overall survival at 1, 5, and 10 years was similar (P = .4) at a mean of 6.22 years follow-up. Stroke incidence was similar at 7.8% versus 3.3% (P = .236).

Conclusions: For patients undergoing aneurysm surgery concomitantly with aortic valve surgery, surgical ablation was effective and did not increase 30-day mortality. Survival and stroke outcomes were similar to a matched reference group without preoperative atrial fibrillation. Ablation of atrial fibrillation should be considered at the time of aortic surgery.

Keywords: aortic valve surgery; ascending aortic aneurysm; atrial fibrillation; surgical ablation.

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Conflict of interest statement

S.C.M.: Edwards Lifesciences: Consulting/Speaker, Research Grants; Medtronic: Consulting/Speaker, Research Grants; Artivion: Consulting/Speaker, Research Grants; Terumo Aortic: Consulting/Speaker, Research Grants. D.R.J.: Advisor for Abbott Labs, Edwards Lifesciences, Terumo Cardiovascular, Livanova Inc, and HD Medical. J.L.C.: consulting fees and meeting/travel support from AtriCure and Adagio Medical; leadership roles and shareholder with AtriCure, Adagio Medical, PAVmed, and Lucid Diagnostics. P.M.M.: Edwards Lifesciences: speaking fees and royalties; AtriCure: speaking fees; Abbott: Surgical primary investigator REPAIR-MR Trial (unpaid); advisory board. C.K.M.: WL Gore: Consulting/Speaker, Research Grant. Baxter: Consulting/Speaking. D.T.P.: Abbott: Surgical Advisor/Consultant; Abiomed: Surgical Advisor/Consultant, Medtronic, Surgical Advisor/Consultant. All 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
One-year survival estimates among matched patient groups undergoing AscAo + AV surgery.
Figure 1
Figure 1
CONSORT flow diagram for patients undergoing elective AscAo repair with and without a preoperative diagnosis of AF. AF, Atrial fibrillation; AV, aortic valve; MV, mitral valve; PV, pulmonic valve; TV, tricuspid valve.
Figure 2
Figure 2
Patient survival. Kaplan–Meier freedom 1-year survival estimates among matched patients. Through the first year of follow-up, survival was similar between the no AF and AF-SA groups (P = .40; 95% CI).
Figure 3
Figure 3
Kaplan–Meier freedom survival estimates among preoperative AF patients with AF follow up 10.5 months or more. For treated AF patients, there was improved survival in those with no AF in follow-up compared with those had AF recurrence (P = .027; 95% CI).
Figure E1
Figure E1
Temporal trends by year in the use of each ablation lesion set over the study period (2008 to 2023). The distribution of AF lesions performed is shown over time. There was a shift from PVI (green lines) to BA lesions (orange lines) over the study period.
Figure E2
Figure E2
Standardized mean differences original and PS matching groups. Absolute values less than 0.2 are generally considered indicative of adequate balance.
See this image and copyright information in PMC

References

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