Safety of Atrial Fibrillation Ablation With Isolated Surgical Aortic Valve Replacement

Background: Surgical ablation of atrial fibrillation (AF) concomitant with cardiac surgery is a Society of Thoracic Surgeons (STS) class I recommendation, although the AF is frequently ignored. Analysis of the STS Database 30-day outcomes of isolated surgical aortic valve replacement (AVR) with and without AF ablation is presented.

Methods: Data on 87,426 surgical aortic valve replacement patients were extracted from the STS database (version 2.81, 2014-2017) and patients were divided into 3 groups: (1) No preoperative AF, (2) Preoperative AF with concomitant ablation, and (3) Preoperative AF without ablation. The latter 2 groups were propensity score-matched in 1-(up)-to-2 ratio to alleviate covariate imbalances and reduce bias. Thirty-day outcomes were evaluated and compared.

Results: Preoperative AF was present in 17.8% (15,596 of 87,426 patients). Ablation was performed in 33.1% (5,167 of 15,596), and 57.7% (2,983) had left atrial appendage closure. Propensity score matching (AF ablated n = 3692; AF non-ablated n = 5724), revealed that there was no difference between the AF ablated and AF non-ablated groups in mortality (2.8% vs 3.0%, respectively; P = .65) or for stroke (1.6% vs 1.7%, respectively; P = .82), but postoperative pacemaker implantation was higher in the AF ablated patients (6.8% AF ablated vs 5.0% AF non-ablated, P < .001).

Conclusions: Despite being a class I recommendation, AF ablation concomitantly with other cardiac surgical procedures remains lower than current guideline recommendation in surgical aortic valve replacement patients. Ablation for AF does not increase the 30-day operative mortality or perioperative morbidity compared with non-ablated patients, although new pacemaker requirements were higher in the AF ablated group.