Concomitant ablation surgery during heart operations boosts long-term survival
Treating atrial fibrillation (AFib) during cardiac surgeries with concomitant surgical ablation (SA) is associated with better long-term patient outcomes, according to a new meta-analysis published in the American Journal of Cardiology.[1]
Care teams have been treating preoperative atrial fibrillation (AFib) with concomitant SA during cardiac surgery for years now, and The Society of Thoracic Surgeons even recommended it in recent clinical practice guidelines.[2] However, the study’s authors noted, data on the long-term effectiveness of this strategy has been inconsistent.
“Although observational studies showed survival benefits of SA during follow-up, those data were limited to highly experienced single centers,” wrote first author Yosuke Sakurai, MD, a resident with the department of surgery with the Marshall University Joan Edwards School of Medicine, and colleagues. “In contrast, RCTs and a meta-analysis of RCTs failed to confirm long-term survival benefits during follow-up, probably because of limited sample sizes or follow-up duration.”
Sakurai et al. aimed to learn more with a meta-analysis of their own, focusing on all-cause mortality during follow-up in addition to stroke, heart failure hospitalizations and other secondary outcomes. They tracked data from 24 different studies and more than 42,000 heart patients. Patients included in these studies underwent mitral valve surgeries, surgical aortic valve replacement and coronary bypass surgery. Most SA procedures were performed using bipolar radiofrequency or cryoablation devices.
The mean patient ages were 66.4 years old for patients who underwent concomitant SA during a cardiac surgery, and 67 years old for patients who did not. The median follow-up period was 62 months, though some studies included up to 85 months of follow-up data.
Overall, concomitant SA for AFib during cardiac surgery was associated with a significantly lower long-term risk of mortality, stroke and heart failure hospitalization than not performing concomitant SA. As one may expect, freedom from AFib was also more common among these patients.
However, SA was linked to an increased risk of requiring a permanent pacemaker. The risk of a bleeding event was similar for both strategies.
Patient age at the time of the procedure and gender did not appear to impact the long-term risk of mortality in any way.
“Historically, rhythm control did not seem to confer survival advantages over rate control based on previous RCTs in the field of cardiology,” the authors wrote. “However, a paradigm shift has been evolving in favor of rhythm control … to decrease cardiovascular morbidity, which is mediated by attaining sinus rhythm. Because SA has been shown to be the most effective treatment option to restore sinus rhythm compared with catheter ablation or antiarrhythmic medication, our results showing the association between SA and late survival benefits would be consistent with these recent growing evidence. SA allows the achievement of more durable transmural lesions, the performance of more complex lesion sets, and left atrial appendage occlusion compared with catheter ablation. These factors may contribute to the observed survival benefits.”
The group also noted that the benefits in terms of stroke may help explain the long-term mortality benefit.
Click here to read the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.