Concomitant surgical atrial fibrillation ablation during aortic valve replacement did not significantly reduce major adverse cardiac events (HR 1.18) but significantly increased sinus rhythm restoration at 4 years.
Observational (n=124)
No
Does concomitant surgical atrial fibrillation ablation improve outcomes in patients with atrial fibrillation undergoing aortic valve replacement?
Concomitant surgical AF ablation during aortic valve replacement significantly improves sinus rhythm restoration and reduces anticoagulation requirements without increasing surgical risk, though it does not significantly impact major adverse cardiac events.
Effect estimate: HR 1.18 (95% CI 0.56-2.49)
Absolute Event Rate: 30% vs 40.5%
p-value: p=0.67
BACKGROUND: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain. METHODS AND RESULTS: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001). CONCLUSIONS: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.
Yoo et al. (Wed,) conducted a observational in Preoperative atrial fibrillation in patients undergoing aortic valve replacement (n=124). Concomitant surgical atrial fibrillation ablation (maze procedure) vs. Aortic valve replacement alone was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (HR 1.18, 95% CI 0.56-2.49, p=0.67). Concomitant surgical atrial fibrillation ablation during aortic valve replacement did not significantly reduce major adverse cardiac events (HR 1.18) but significantly increased sinus rhythm restoration at 4 years.