Does Preoperative Sinus Rhythm Influence Surgical Ablation’s Perioperative Safety in Patients with Atrial Fibrillation?

Authors

  • Maximilian Vondran, MD Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg, Germany
  • Tamer Ghazy, MD, PhD Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg, German
  • Marc Albert, MD Department of Cardiac and Vascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany
  • Henning Warnecke, MD, PhD Department of Cardiac Surgery, Schuechtermann-Klinik, Bad Rothenfelde, Germany
  • Mirko Doss, MD, PhD Department of Cardiovascular Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
  • Andreas Liebold, MD, PhD Department of Cardiothoracic and Vascular Surgery, Ulm University Hospital, Ulm, Germany
  • Edgar Eszlari, MD, PhD Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany
  • Etem Caliskan, MD Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
  • Taoufik Ouarrak, Dipl. Biol. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
  • Nicolas Doll Department of Cardiac Surgery, Sana Heart Center, Stuttgart, Germany
  • Jochen Senges, MD, PhD Stiftung Institut für Herzinfarktforschung, Ludwigshafen, German
  • Thorsten Hanke, MD, PhD Department for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, German
  • Ardawan J. Rastan, MD, PhD Department of Cardiac and Vascular Surgery, Herz-Kreislauf-Zentrum, Rotenburg, Germany

DOI:

https://doi.org/10.1532/hsf.3995

Keywords:

atrial fibrillation, sinus rhythm, surgical ablation, maze procedure, cardiac surgery

Abstract

Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, currently, only 25–40% of atrial fibrillation (AF) patients undergo simultaneous surgical ablation therapy (SA) during cardiac surgery. Surgeon’s fear exposing their patients to an additional, unjustified, and disproportionate risk when performing SA in AF patients presenting with sinus rhythm (SR) before surgery. To clarify the influence of preoperative SR before SA for AF, we conducted a subgroup analysis of the German Cardiosurgical Atrial Fibrillation (CASE-AF) register.

Methods: Between September 2016 and August 2020, 964 AF patients with an underlying cardiac disease were scheduled for surgery with SA and enrolled in the CASE-AF register. Data prospectively were collected and analyzed retrospectively. We divided the entire cohort into an SR-group (38.2%, N = 368) and an AF-group (61.8%, N = 596), based on preoperative heart rhythm.

Results: Over half of the patients were moderately affected by their AF, with no difference between the groups (European Heart Rhythm Association class ≥IIb: SR-group 54.2% versus AF-group 58.5%, P = .238). The AF-group had a higher preoperative EuroSCORE II (4.8 ± 8.0% versus 4.2 ± 6.3%,
P = .014). In-hospital mortality (SR-group 0.8% versus AF-group 1.7%, P = .261), major perioperative adverse cardiac and cerebrovascular events (SR-group 2.7% versus AF-group 3.5%, P = .500), and the new pacemaker implantation rate (SR-group 6.0% versus AF-group 5.9%, P = .939) were low and showed and no group difference. Logistic regression analysis showed a protective effect for preoperative SR to perioperative complications in AF patients undergoing SA (odds ratio (OR) 0.72 (95% CI 0.52 - 0.998); P = .0485).

Conclusions: Concomitant SA in AF patients presenting in SR before cardiac surgery is safe, has a low perioperative risk profile, and should be carried out with almost no exceptions.

Author Biography

Nicolas Doll, Department of Cardiac Surgery, Sana Heart Center, Stuttgart, Germany

1Department of Cardiac Surgery, Sana Heart Center, Stuttgart, Germany

2Department of Cardiac Surgery, Schuechtermann-Klinik, Bad Rothenfelde, Germany

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Published

2021-09-08

How to Cite

Vondran, M., Ghazy, T., Albert, M., Warnecke, H. ., Doss, M. ., Liebold, A. ., Eszlari, E. ., Caliskan, E. ., Ouarrak, T. ., Doll, N., Senges, J., Hanke, T. ., & Rastan, A. (2021). Does Preoperative Sinus Rhythm Influence Surgical Ablation’s Perioperative Safety in Patients with Atrial Fibrillation?. The Heart Surgery Forum, 24(5), E785-E793. https://doi.org/10.1532/hsf.3995

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