Key result
Endocardial cryoablation during surgical ablation for long-standing persistent AF was significantly associated with freedom from AF recurrence at 1 year (OR 2.7; 95% CI 1.07-6.79; P=0.035).
Why the study?
The study aimed to evaluate 1-year outcomes of surgery for long-standing persistent AF using real-world data from a prospective multicentre registry.
Observational (n=202)
Yes
Odds Ratio: 2.7 (95% CI 1.07–6.79)
p-value: p=0.035
Surgical ablation for long-standing persistent AF achieves freedom from recurrence in 56% of patients at 1 year, with endocardial cryoablation demonstrating superior efficacy.
Cryoablation was associated with greater AF freedom after surgical ablation; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVES: The CArdioSurgEry Atrial Fibrillation (CASE-AF) registry is a prospective, multicentre study for collecting and analysing real-world data of surgical atrial fibrillation (AF) treatment. This study aimed to evaluate outcomes of surgery for long-standing persistent AF at 1 year. METHODS: In total, 17 centres consecutively include all eligible patients with continuous AF lasting for ≥1 year. Exclusion criteria are missing informed consent or age <18 years. For patient-reported outcomes measures, the European Heart Rhythm Association score was used. No presence of AF (based on ECG findings including Holter ECG and/or implanted devices), no re-ablation, no further cardioversion and no rehospitalization due to AF after a 3-month blanking period defined no AF recurrence at 1 year. RESULTS: From January 2017 to January 2020, a total of 1115 patients were enrolled in CASE-AF. Of them, 202 patients (mean age 69.7 ± 7.8 years, 27.2% female) underwent surgical ablation of long-standing persistent AF (study cohort), mostly accompanied by left atrial appendage closure (n = 180 [89%], resection n = 75 [42%]) and predominantly performed as concomitant (n = 174 [86%]) and left atrial only procedure (n = 144 [71%]). Early mortality (30 days) was 2.0% and morbidity was low. At follow-up (median 14.4 months, interquartile range, 12.7-17.6 months, 100% complete), 106 patients (56%) had no AF recurrence and 93% of them were asymptomatic. AF recurrence was accompanied by AF-related rehospitalization (n = 12, P = 0.003), direct current shock cardioversion (n = 23, P < 0.001), AF ablation (n = 7, P = 0.003) and stroke (n = 3, P = 0.059). Multivariable analysis identified cryoablation, predominantly performed endocardially including additional left atrial (74%) and biatrial (42%) lesions, as a significant factor for freedom from AF recurrence (odds ratio 2.7, 95% confidence interval 1.07-6.79, P = 0.035). CONCLUSIONS: According to CASE-AF, surgical ablation of long-standing persistent AF is most effective when concomitantly performed using endocardial cryoablation. Ongoing follow-up allows further elucidation of efficacious treatment strategies.
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Grubitzsch et al. (2023) conducted an observational in Long-standing persistent atrial fibrillation (n=202). Endocardial cryoablation vs. Other surgical ablation methods was evaluated on Freedom from AF recurrence at 1 year (OR 2.7, 95% CI 1.07-6.79, p=0.035). Endocardial cryoablation during surgical ablation for long-standing persistent AF was significantly associated with freedom from AF recurrence at 1 year (OR 2.7; 95% CI 1.07-6.79; P=0.035).
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