Concomitant treatment of atrial fibrillation during mitral valve surgery

Monika Hałas; Jane Kruse; Patrick M. McCarthy

doi:10.1111/jce.15019

March 30, 2021Journal of Cardiovascular Electrophysiology

Concomitant treatment of atrial fibrillation during mitral valve surgery

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Why the study?

Despite evidence and a Class I recommendation for surgical ablation concomitant to mitral valve surgery, its utilization remains low.

Does surgical ablation concomitant to mitral valve surgery improve outcomes in patients with pre-existing atrial fibrillation?

Structured PICO

Does surgical ablation concomitant to mitral valve surgery improve outcomes in patients with pre-existing atrial fibrillation?

P

Population

Patients presenting with atrial fibrillation before mitral valve surgery

I

Intervention

Surgical ablation concomitant to mitral valve surgery

C

Comparator

Atrial fibrillation left untreated during mitral valve surgery

O

Outcome

Perioperative mortality and morbidity, freedom from AF, long-term survival, and stroke rateshard clinical

Concomitant surgical ablation during mitral valve surgery is safe, improves late survival, and should be utilized more consistently in accordance with Class I guidelines.

Implication

Supports concomitant ablation in mitral valve surgery with AF; leaves open randomized confirmation of survival benefit.

Abstract

INTRODUCTION: Surgical management of atrial fibrillation (AF) is a well-established method of preventing complications and late mortality in patients presenting with AF before mitral valve (MV) surgery. However, despite a substantial body of evidence and a Class I recommendation to apply surgical ablation (SA) concomitant to MV surgery, the utilization of SA remains low. METHODS: In this study, we sought to summarize the current trends in the SA of AF during MV surgery and update the medical community on its advantages, including perioperative mortality and morbidity, freedom from AF, as well as long-term survival and stroke rates. RESULTS: The data indicate that SA can be added with no increased risk (and perhaps a reduction in perioperative risk) and improved late survival compared to patients with AF left untreated during MV surgery. DISCUSSION: Inconsistent application of SA may be related to inaccurate perceptions regarding the complexity of the procedure itself, extended cross-clamp and bypass times with attendant increased risks, views that it is ineffective, and increased need for an early pacemaker. CONCLUSION: Education in the proper performance of SA, including careful placement of the lesions and attainment of the full transmural effect, contributes to procedure success. Propagating the safety and positive outcomes may also address the concerns.