Key result
Concomitant left atrial ablation increases 1-year sinus rhythm odds by ~640% vs cardiac surgery alone.
Why the study?
Does left atrial concomitant surgical ablation improve sinus rhythm prevalence and freedom from atrial fibrillation in patients with permanent or persistent atrial fibrillation undergoing cardiac surgery?
Meta-Analysis (n=666)
Does left atrial concomitant surgical ablation improve sinus rhythm prevalence and freedom from atrial fibrillation in patients with permanent or persistent atrial fibrillation undergoing cardiac surgery?
Concomitant left atrial surgical ablation during cardiac surgery safely and effectively restores sinus rhythm in patients with persistent or permanent atrial fibrillation without increasing perioperative morbidity or mortality.
Answers are grounded in this paper and cite their sources.
Supports concomitant ablation during cardiac surgery for AF; confirms rhythm benefit in Level 1 evidence without excess morbidity.
INTRODUCTION: Surgical ablation is a generally established treatment for patients with atrial fibrillation undergoing concomitant cardiac surgery. Left atrial (LA) lesion set for ablation is a simplified procedure suggested to reduce the surgery time and morbidity after procedure. The present meta-analysis aims to explore the outcomes of left atrial lesion set versus no ablative treatment in patients with AF undergoing cardiac surgery. METHODS: A literature research was performed in six database from their inception to July 2017, identifying all relevant randomized controlled trials (RCTs) comparing left atrial lesion set versus no ablative treatment in AF patient undergoing cardiac surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Eleven relevant RCTs were included for analysis in the present study. The prevalence of sinus rhythm in ablation group was significantly higher at discharge, 6-month and 1-year follow-up period. The morbidity including 30 day mortality, late all-cause mortality, reoperation for bleeding, permanent pacemaker implantation and neurological events were of no significant difference between two groups. CONCLUSIONS: The result of our meta-analysis demonstrates that left atrial lesion set is an effective and safe surgical ablation strategy for AF patients undergoing concomitant cardiac surgery.
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Wang et al. (2018) conducted a meta-analysis in Permanent or persistent atrial fibrillation (n=666). Left atrial surgical ablation vs. Cardiac surgery alone was evaluated on Sinus rhythm prevalence at 1-year follow-up (OR 7.40, 95% CI 3.97-13.79, p=<0.00001). Left atrial surgical ablation concomitant with cardiac surgery significantly increased the prevalence of sinus rhythm at 1-year follow-up compared to cardiac surgery alone (55.1% vs. 20.8%, OR 7.40).
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