Despite guideline recommendations, there is significant practice variation among cardiac surgeons in the application and techniques of concomitant surgical ablation for atrial fibrillation.
Background: Surgical ablation of atrial fibrillation (AF) during cardiac surgery is a guideline-recommended procedure with demonstrated effectiveness in restoring sinus rhythm.Nonetheless, rates of utilization are relatively low, which needs to be better understood.Methods: This study used an electronically distributed survey to characterize the use, techniques, and clinical indications for concomitant AF ablation among cardiac surgeons.Results: Of the 362 surveys distributed internationally, 79 responses were received (22%).After excluding three incomplete responses, 76 surveys were included in the final analysis.Majority of respondents (67/76, 88%) reported performing concomitant surgical ablation of AF.Amongst surgeons who perform AF ablation, practice variation was observed.Pulmonary vein isolation was the most common lesion set (45%), and over half of surgeons (52%) tailored lesion selection to AF type, favouring more extensive ablation for persistent AF.Regarding patient selection, notable deterrents to concomitant ablation included: increased left atrial size, more persistent forms of AF, severe left ventricular dysfunction, reoperation, minimally invasive surgeries, and complex cases with long pump times.Among non-ablating surgeons (9/76, 12%), common factors reported to increase future adoption of AF ablation included stronger clinical evidence and more affordable and accessible equipment.Conclusions: Our findings reveal that surgical ablation of AF is performed by the majority of research-active cardiac surgeons, yet meaningful variation persists in how and when it is applied.These findings underscore the need for a welldesigned, definitive trial to guide future care and address the gap between recommendations and practice.
Fournier et al. (Wed,) studied this question.