Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w

Is temporally sinus rhythm in patients with atrial fibrillation a reason NOT to perform a concomitant surgical ablation during cardiac surgery?

M. Vondran1, T. Ghazy1, M. Albert2, H. Warnecke3, M. Doss4, A. Liebold5, E. Eszlari6, T. Ouarrak7, N. Doll3, J. Senges7, T. Hanke8, A. Rastan1, für die Studiengruppe: CASE-AF

1Herz- und Gefäßchirurgie, Herz-Kreislauf-Zentrum, Rotenburg; 2Herz- und Gefäßchirurgie, Robert-Bosch-Krankenhaus, Stuttgart; 3Herzchirurgie, Schuechtermann-Klinik, Bad Rothenfelde; 4Abteilung für Herzchirurgie, Kerckhoff Klinik GmbH, Bad Nauheim; 5Herzchirurgie, Universitätsklinikum Ulm, Ulm; 6Herzchirurgie, Klinikum Bogenhausen, München; 7Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein; 8I. Medizinische Abteilung, Kardiologie, Asklepios Klinikum Harburg, Hamburg;

BACKGROUND: Despite excellent data to reduce long-term stroke and all-cause mortality rate by concomitant surgical ablation therapy (SA) for atrial fibrillation (AF), only 25–40% of the AF patients were ablated simultaneously during cardiac surgery. Patients with AF presenting in sinus rhythm (SR) before surgery might be temporally asymptomatic; why surgeons fear that they are exposing these patients to an additional, unjustified, and disproportionate risk. 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 09/2016 and 08/2020, 964 AF patients with an underlying cardiac disease were scheduled for surgery with SA and enrolled in the CASE-AF register. At the time of surgery, 368 patients (38.2%) had a sinus rhythm. Data were prospectively collected and analyzed retrospectively. RESULTS: More than half of the patients were moderately affected by their atrial fibrillation in everyday life (class of the European Heart Rhythm Association ≥IIb: 54.2%), despite the present sinus rhythm at the time of surgery. The preoperative EuroSCORE II was 4.2±6.3%. Perioperative major adverse cardiac and cerebrovascular events were 2.7%, and the new pacemaker implantation rate was 6.0%. At discharge, in 81.3% of the patients, a sinus rhythm could be preserved. Logistic regression analysis showed a protective effect on perioperative complications (combined endpoint of any complications occurred that can be linked to the surgery) for the patients in SR before cardiac surgery with SA (Odds ratio (OR) 0.72 (95% CI 0.52 - 0.998); p=0.0485) (calculated as a comparison against the patients operated in AF out of the CASE-AF register). CONCLUSION: Concomitant SA in AF patients with preoperative SR undergoing cardiac surgery is safe and with a low perioperative risk profile and should be performed without exception.

https://dgk.org/kongress_programme/jt2021/aP606.html