Impact of surgical ablation of atrial fibrillation on ventricular function and remodeling after aortic valve replacement

Abstracts OBJECTIVES While aortic valve replacement (AVR) improves left ventricular (LV) function and promotes LV remodelling, it remains uncertain whether surgical ablation (SA) provides additional functional and structural benefit in patients with atrial fibrillation (AF). We aimed to evaluate the association of SA with LV function, remodelling, and clinical outcomes in AF patients undergoing AVR. METHODS We analyzed AF patients undergoing AVR between 2000 and 2023. Inverse-probability-of-treatment weighting (IPTW) was used to adjust for baseline differences. Temporal changes in LV ejection fraction (LVEF) and LV mass index (LVMI) were assessed using nonlinear mixed-effect models based on 1,974 echocardiographic measurements. RESULTS Among 389 patients (aged 68.8 ± 8.2 years), 258 (66.3%) underwent SA. In the IPTW-adjusted cohort, SA was not associated with increased operative mortality (P = 0.262). During a median follow-up of 5.2 years, all-cause mortality (P = 0.174) and stroke (P = 0.580) were similar between groups. In longitudinal analyses, SA showed a non-significant trend towards higher LVEF in the overall cohort (inter-group P = 0.055) and no significant differences in LVMI (P = 0.158). In patients with ≥3 echocardiograms (n = 248), between-group differences became significant, with higher LVEF (5-year difference +3.0%; 95% confidence interval [CI], +0.3 to + 5.4; P = 0.031, inter-group P = 0.003) and lower LVMI (1-year difference −13.0 g/m2; 95% CI, −20.4 to − 5.4; P = 0.003, inter-group P = 0.032). Associations were more pronounced in patients with aortic stenosis. CONCLUSIONS SA during AVR was associated with modestly more favorable LV remodelling without increasing operative or long-term clinical risks. Given small absolute differences, these findings should be interpreted cautiously, and further studies with longer follow-up are warranted.