Late Survival Benefits of Concomitant Surgical Ablation for Atrial Fibrillation During Cardiac Surgery: A Systematic Review and Meta-Analysis.

Autor: Sakurai Y; Department of Surgery, Marshall University Joan Edwards School of Medicine, West Virginia., Kuno T; Division of Cardiology, Massachusetts General Hospital, Havard Medical School, Massachusetts. Electronic address: kuno-toshiki@hotmail.co.jp., Yokoyama Y; Department of Cardiac Surgery, University of Michigan, Michigan., Fujisaki T; Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan., Balakrishnan P; Department of Surgery, Marshall University Joan Edwards School of Medicine, West Virginia., Takagi H; Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan., Kaneko T; Division of Cardiothoracic Surgery, Washington University in St Louis, St Louis, Missouri.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Oct 28; Vol. 235, pp. 16-29. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1016/j.amjcard.2024.10.008
Abstrakt: The long-term survival benefits after surgical ablation for atrial fibrillation (AF) during cardiac surgery were not confirmed in previous randomized controlled trials or meta-analyses. This study aimed to investigate the long-term efficacy of surgical ablation in patients with AF. MEDLINE, EMBASE, and CENTRAL were searched to identify studies comparing concomitant surgical AF ablation with no surgical ablation during cardiac surgery. The primary outcome was long-term all-cause mortality. Secondary outcomes were stroke, heart failure rehospitalization, major bleeding, freedom from AF, and permanent pacemaker implantation during follow-up. To minimize confounding, only adjusted outcomes were used from observational studies. A total of 38 studies met the inclusion criteria. Of those, 9 randomized controlled trials and 15 observational studies with 41,678 patients (surgical ablation: n = 19,125; no surgical ablation: n = 22,553) were analyzed for all-cause mortality, with a weighted median follow-up of 62.0 months. Surgical ablation was associated with decreased risks of long-term mortality (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.71 to 0.84), stroke (HR 0.60, 95% CI 0.48 to 0.76), heart failure rehospitalization (HR 0.92, 95% CI 0.87 to 0.96), and more freedom from AF during follow-up (relative risk 1.93, 95% CI 1.50 to 2.49), whereas surgical ablation was associated with a higher risk of permanent pacemaker implantation during follow-up (HR 1.35, 95% CI 1.03 to 1.77). There was no significant difference in major bleeding during follow-up between the 2 groups. In patients with AF who underwent cardiac surgery, surgical ablation was associated with decreased risks of long-term mortality, stroke, and heart failure rehospitalization compared with patients with untreated AF. Given that the survival benefits were predominantly observed in observational studies, further randomized trials are necessary to confirm these findings.
Competing Interests: Declaration of competing interest Dr. Kaneko has received consulting fees from Edwards Lifesciences, Medtronic, 4C Medical, CardioMech, Cook Medical; and has been a speaker for Abbott and Baylis. The remaining authors have no competing interests to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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