Concomitant surgical ablation for treatment of atrial fibrillation in patients undergoing cardiac surgery

Abstract

Surgical ablation is a well-established therapy for patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not clear if this translates to an improvement in patient important outcomes such as mortality, stroke, and quality of life (QoL). Electronic searches were performed of Ovid Medline and PubMed from their inception to October 2021. Eligible literature included comparative studies with patient undergoing surgical ablative treatment for AF concomitant to any cardiac surgery procedure and patients without specific AF treatment. For this paper, the studies listed are presented descriptively without statistical processing or collection of a metaanalysis. Freedom from AF at 1 year was consistently shown to be improved by surgical ablation. No differences in 30-day mortality or in safety outcomes were observed between the group who received ablation and the control group. A significant increase in pacemaker implantation in the ablation group was generally detected among studies, especially if the lesions were biatrial. Amongst the studies that reported on health-related quality of life (HRQoL) a statistically significant improvement was seen in the ablation group over the control, especially in the physical domains. Surgical ablation is the most effective procedure to treat AF during cardiac surgery, and it is a unique opportunity to return to sinus rhythm with no added mortality risk and a potential improvement in quality of life. There is however an increased risk of pacemaker implantation and complications such as renal failure which must be weighed with tailored treatment and patient selection. It is also not clear how long-term outcomes are affected due to underpowered randomized controlled trials. This review summarized short term outcomes of concomitant AF treatment during cardiac surgery and highlight the importance of reporting long-term outcomes to confirm the benefits.