Preoperative CHA₂DS₂-VASc Score is Associated With Postoperative Survival Following Surgical Ablation Concomitantly With Other Cardiac Surgery

Background: The CHA₂DS₂-VASc scoring system has been shown to predict long-term outcomes in patients undergoing catheter ablation but has not yet been investigated for patients undergoing surgical ablation. Therefore, the objective was to evaluate the ability of CHA₂DS₂-VASc to predict long-term outcomes after surgical ablation.

Method: In a retrospective study, patients were included if they underwent surgical ablation concomitantly with other cardiac surgery. Patients were divided into low-risk (score 0-1), medium-risk (score 2-4) and high-risk (score ≥5) groups based on their CHA₂DS₂-VASc score. Data on survival, atrial fibrillation (AF) recurrence, and stroke were collected retrospectively at the end of the follow-up period.

Results: A total of 587 patients underwent surgical ablation concomitantly with other cardiac surgery. Survival analysis revealed a difference between the three stratified CHA₂DS₂-VASc risk groups, (p<0.001). Similarly, there was a difference in AF recurrence rates between stratified CHA₂DS₂-VASc groups among patients with persistent/long-standing persistent AF (p=0.018). There were no statistically significant differences between stratified CHA₂DS₂-VASc risk groups in terms of recurrence rates of paroxysmal AF or stroke. Finally, the CHA₂DS₂-VASc scoring system was an independent predictor of 5-year mortality after adjusting for potential confounders (hazard ratio 1.25; p=0.002).

Conclusions: Preoperative CHA₂DS₂-VASc scores were associated with postoperative survival in patients undergoing surgical ablation for AF. Post-hoc analyses showed that CHA₂DS₂-VASc was also a predictor of AF recurrence in patients with persistent/long-standing persistent AF. However, this needs to be confirmed in a prospective study.