SHOULD WE ABLATE ATRIAL FIBRILLATION DURING CORONARY ARTERY BYPASS GRAFTING AND AORTIC VALVE REPLACEMENT?

Abstract

Atrial fibrillation (AF) is associated with significant morbidity and mortality. Whether adding AF ablation to coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) raises the operative risk remains unclear. Herein we evaluate the safety and efficacy of concomitant AF ablation during CABG and/or AVR in contemporary patients. This is a single-center retrospective study of prospectively collected data. All patients with preoperative AF presenting for CABG and/or AVR between 2009 and 2013 were included. These patients were divided into an intervention group that underwent concomitant AF ablation and a control group that did not. Preoperative, operative, and postoperative data was obtained on all patients. Patients with preoperative AF (n=375) presenting for CABG (44%), AVR (27%), or combined CABG/AVR (29%), were divided into an intervention (n=129) and control (n=246) groups. Both groups had similar baseline characteristics except for a younger intervention group (71±1 vs. 74±1 years, p=0.048) with higher male proportion (80% vs. 70%, p=0.031). The intervention group had less redo (4% vs. 11%, p=0.015) and AVR cases (19% vs. 31%, p=0.017) balanced by more CABG (50% vs. 41%, p=0.113) and combined cases (31% vs. 28%, p=0.549), with a similar urgency profile. The intervention significantly lengthened surgery, cardiopulmonary bypass, and cross-clamp times, adding a mean of 32±5, 31±3, and 22±3 minutes, respectively. Both groups had similar unadjusted rates of in-hospital mortality, myocardial infarction, stroke, reopening, acute renal failure, and prolonged ventilation. The intensive care and hospital length of stays were similar. Postoperative AF was significantly lower in the intervention group (27% vs. 78%, p<0.0001). After adjusting for clinical and operative characteristics, the intervention group showed a trend towards lower odds of mortality (p=0.058) and prolonged ventilation (p=0.078), and significantly lower odds of postoperative AF (OR 0.07; p<0.001) compared to controls. To date, this represents the largest contemporary data demonstrating that patients with preoperative AF undergoing CABG and/or AVR can safely undergo concomitant AF ablation without increased surgical risk. Moreover, surgical AF ablation in this patient population is effective at reducing the burden of postoperative AF.