Variability in Adoption of Surgical Ablation of Atrial Fibrillation: An International Survey of Cardiac Surgeons

Q: What does this research mean for the field?

Although surgical ablation of atrial fibrillation is performed by a majority of surveyed research-active cardiac surgeons, significant variation persists in its application, techniques, and patient selection, highlighting a gap between guideline recommendations and clinical practice. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Renee Fournier; Richard P. Whitlock; William F. McIntyre; Adam Eqbal; Rachel Eikelboom; Philippe Tremblay; Manuel Castellà; Yoan Lamarche; Gianluigi Bisleri; Éric Charbonneau; Saurabh Gupta; Steven Meyer; Ondřej Szárszoi; Emilie P. Belley‐Côté

doi:10.1016/j.cjco.2026.04.002

April 1, 2026CJC OpenOpen Access

Variability in Adoption of Surgical Ablation of Atrial Fibrillation: An International Survey of Cardiac Surgeons

View Full Paper

Ask AI

Bookmark

Share

Figures

Why the study?

Surgical ablation of AF during cardiac surgery is guideline-recommended, yet rates of utilization remain relatively low and need to be better understood.

Key Points

The study aims to understand the variability in the adoption of surgical ablation for atrial fibrillation among cardiac surgeons globally.
Electronically distributed survey to cardiac surgeons
Characterized use, techniques, and clinical indications for AF ablation
Analyzed responses from 76 complete surveys
88% of surgeons reported performing concomitant surgical ablation of AF
Pulmonary vein isolation was the most common lesion set, used by 45% of surgeons
Over 50% tailored lesion selection to AF type, preferring extensive ablation for persistent AF
12% of surgeons did not perform ablation, citing barriers like left atrial size and severe left ventricular dysfunction

Structured PICO

P

Population

76 cardiac surgeons responding to an international survey

I

Intervention

Concomitant surgical ablation of atrial fibrillation during cardiac surgery

O

Outcome

Use, techniques, and clinical indications for concomitant AF ablation

Despite guideline recommendations, there is significant practice variation among cardiac surgeons in the application and techniques of concomitant surgical ablation for atrial fibrillation.

Implication

Supports integration of concomitant AF ablation during cardiac surgery; reinforces guidelines but leaves open barriers to broader utilization.

Abstract

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.