Reality of surgical treatment of atrial fibrillation in the Czech Republic – Data from the National Register of Cardiac Surgery (2010–2015)

Abstract

IntroductionSurgical ablation is an established treatment for atrial fibrillation (AF) in certain patients indicated for cardiac surgery. However, several strategies and approaches exist at different centers and no recent reports exist about current trends in AF treatment in the Czech Republic. We examined the national trends of concomitant and stand-alone surgical ablation of AF. MethodsData from the National Register of Cardiac Surgery and from a special questionnaire, created especially for this analysis, were used for evaluation of trends in the rate of concomitant surgical ablations in AF patients, rates of different concomitant procedures, and to analysis those factors that surgeons routinely used to reject AF treatment during cardiac surgery. Data about stand-alone AF surgery were also gathered and analyzed. The study period lasted from 2010–2015. ResultsOverall, 54% of cardiac surgery patients with history of AF received a concomitant surgical ablation procedure; this percentage declined slightly over the study period from 59% in 2010 to 51% in 2015. Concomitant ablation was most often performed on mitral valve patients (71%) and least often during isolated coronary revascularization (40%). In a multivariant analysis, age, history of myocardial infarction, history of cardiac surgery, renal failure, severe systolic dysfunction of the left ventricle (i.e., ejection fraction ≤30%), and preoperative hemodynamic instability were identified as strongest independent factors that causes surgeons to reject AF treatment during an non-AF cardiac surgery. Stand-alone AF surgery was performed in 9 (75%) Czech centers during the study period with a total of 132 procedures; this method has been abandoned by most centers, while several have switched to a hybrid ablation (HA) strategy. Hybrid ablation programs were ongoing in 5 centers in 2016, the overall number of procedures through the end of 2015 was 144. ConclusionsThe prevalence of surgical AF treatment in cardiac surgery patients has been slightly decreasing, and in almost half of the patients AF was left untreated. Stand-alone AF surgery has been nearly abandoned, while hybrid treatment has slowly expanded in Czech centers.