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Thorac Cardiovasc Surg
DOI: 10.1055/a-2334-9039
Original Cardiovascular

Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Bernd Niemann
1   Justus-Liebig-Universität Giessen, UKGM - Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Giessen, Hessen, Germany
,
Nicolas Doll
2   Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Niedersachsen, Germany
,
Herko Grubitzsch
3   Charite Medical Faculty Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum der Charité (DHZC), Charité – Universitätsmedizin Berlin, Berlin, Germany
,
Thorsten Hanke
4   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Asklepios Klinik Harburg, Hamburg, Germany
,
Michael Knaut
5   Department of Cardiac Surgery, Heart Center Dresden, Dresden, Germany
,
Jochen Senges
6   Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
,
Taoufik Ouarrak
6   Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
,
Maximilian Vondran
7   Department for Cardiac Surgery, Karlsburg Hospital, Karlsburg, Mecklenburg-Vorpommern, Germany
,
Andreas Böning
8   Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
› Institutsangaben Funding This study was supported by the AtriCure Europe.
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Abstract

Background Surgical atrial ablation is evaluated by surgeons in relation to the estimated surgical risk. We analyze whether high-risk patients (HRPs) experience risk escalation by ablation procedures.

Methods The CASE-Atrial Fibrillation (AF) registry is a prospective, multicenter, all-comers registry of atrial ablation in cardiac surgery. We analyzed the 1-year outcome regarding survival and rhythm endpoints of 1,000 consecutive patients according to the operative risk classification (EuroSCORE II ≤ 2 vs. >2).

Results Higher NYHA (New York Heart Association) score, ischemic heart failure, status poststroke, renal insufficiency, chronic obstructive pulmonary disease, and diabetes mellitus were strongly represented in HRPs. HRPs exhibit more left ventricular ejection fraction < 40% (19.2 vs. 8.8%; p < 0.001) but identical left atrial diameter and left ventricular end-diastolic diameter compared with low-risk patients (LRPs). CHA2DS-Vasc-score (2.4 ± 1 vs. 3.6 ± 1.5; p < 0.001), sternotomies, combination surgeries, coronary artery bypass graft, and mitral valve procedures were increased in HRPs. LRPs underwent stand-alone ablations as well. Ablation energy did not differ. Left atrial appendage closure was performed in up to 86.1% (mainly cut-and-sew procedures). Mortality corresponded to the original risk class without an escalation that may be related to ablation, stroke rate, or myocardial infarction. A total of 60.6% of HRPs versus 75.1% of LRPs were discharged in sinus rhythm. Long-term EHRA (European Heart Rhythm Association) score symptoms were lower in HRPs. Repeated rhythm therapies were rare. Additional antiarrhythmics received a minority without group dependency. A total of 1.6 versus 4.1% of HRPs (p = 0.042) underwent long-term stroke; excess mortality was not observed. Anticoagulation remained common in HRPs.

Conclusion Surgical risk and long-term mortality are determined by the underlying disease. In HRPs, freedom from AF and symptom relief can be achieved. Preoperative risk scores should not lead to withholding an ablation procedure.

Keywords

arrhythmia therapy - outcomes - surgery - complications

Note

This study was accepted for presentation at the DGTHG annual meeting 2024 in Hamburg, Germany. Its abstract was ranked among the top 25 submissions.


Authors' Contribution

B.N., N.D., H.G., T.H., M.K., J.S., M.V. and A.B. contributed to conception and design of the scientific project. B.N., N.D., H.G., T.H., M.K., M.V. and A.B. performed and organized data collection. N.D., T.H. and J.S. performed the curation and administration of the CASEAF registry and control of data integrity. Analysis and interpretation of data was performed by B.N., T.O., J.S. and A.B.. B.N., T.O. and J.S. performed statistical analysis. B.N., N.D., H.G., T.H., M.K., J.S., T.O., M.V. and A.B. were responsible for drafting, B.N. and A.B. for writing and editing of the manuscript. B.N., N.D., H.G., T.H., M.K., J.S., T.O., M.V. and A.B. performed critical revision and correction of the manuscript.


Supplementary Material



Publikationsverlauf

Eingereicht: 30. Januar 2024

Angenommen: 27. Mai 2024

Accepted Manuscript online:
28. Mai 2024

Artikel online veröffentlicht:
27. Juni 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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