# Concomitant Surgical Ablation in Atrial Fibrillation Patients Undergoing Cardiac Surgery for Isolated Coronary and Aortic Valve Disease: A Multicentre Study from The Netherlands Heart Registration

## TL;DR

This study examines the outcomes of concomitant surgical ablation in patients with atrial fibrillation undergoing heart surgery in the Netherlands, finding longer surgical times but better survival and quality of life.

## Contribution

The study provides new insights into the effectiveness of concomitant surgical ablation in non-mitral valve surgeries like CABG and AVR.

## Key findings

- CSA patients had longer cardiopulmonary bypass and aortic cross clamping times.
- CSA was associated with higher survival rates and improved mental quality of life.
- CSA performance during CABG and AVR increased from 29.7% in 2018 to 44.4% in 2021.

## Abstract

Concomitant surgical ablation (CSA) is recommended for atrial fibrillation (AF) patients undergoing cardiac surgery; however, its effects in non-mitral valve surgeries, specifically coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), are less studied. This study aims to analyse outcomes and trends of CSA performance in the Netherlands.

This nationwide multicentre study utilized data from the Netherlands Heart Registration. AF patients undergoing CABG or AVR between 2013 and 2021 were included. Temporal trends in CSA performance were analysed and a multivariable regression model adjusted for confounders when comparing CSA and non-CSA.

A total of 3260 patients were included, of which 1081 underwent CSA. CSA patients showed longer cardiopulmonary bypass (CPB) (111 vs 80, mean difference between groups: 31 min [95% CI, 27-34, P < 0.001]) and aortic cross clamping (AoX) times (67 vs 52, mean difference: 15 min [95% CI, 13-17, P < 0.001]). After correcting for confounders, CSA patients presented mean CPB and AoX times of 18 (95% CI, 16-21, P < 0.001) and 8 (95% CI, 6-10, P < 0.001) min longer. The CSA group showed higher survival rates (92.5% vs 86.4%, P = 0.039) and greater improvements in mental quality of life (QoL) (P = 0.047). CSA performance during CABG and AVR has increased significantly, from 29.7% in 2018 to 44.4% in 2021.

CSA resulted in slightly longer CPB and AoX times but no significant differences in major complications. Regression analysis showed better survival rates and improved mental QoL for CSA. CSA performance in CABG and AVR has increased in the Netherlands.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, associated with significant morbidity, mortality, and increased healthcare costs.