Surgical ablation, left atrial appendage occlusion or both? Nationwide registry analysis of cardiac surgery patients with underlying atrial fibrillation
Authors: Pasierski Michał , Batko Jakub , Kuźma Łukasz , Wańha Wojciech , Jasiński Marek , Widenka Kazimierz , Deja Marek , Bartuś Krzysztof , Hirnle Tomasz , Wojakowski Wojciech , Lorusso Roberto , Tobota Zdzisław , Maruszewski Bohdan J , Suwalski Piotr , Kowalewski Mariusz ,   KROK Investigators, Anisimowicz Lech , Bartuś Krzysztof , Biederman Andrzej , Borkowski Dariusz , Brykczyński Mirosław , Bugajski Paweł , Burysz Marian , Cholewiński Paweł , Cichoń Romuald , Cisowski Marek , Deja Marek , Dziatkowiak Antoni , Gburek Tadeusz , Gerber Witold , Gryczko Leszek , Haponiuk Ireneusz , Hendzel Piotr , Hirnle Tomasz , Jabłonka Stanisław , Jarmoszewicz Krzysztof , Jasiński Jarosław , Jasiński Marek , Jaszewski Ryszard , Jemielity Marek , Kalawski Ryszard , Kapelak Bogusław , Karolczak Maciej A , Kaperczak Jacek , Knapik Piotr , Krejca Michał , Kustrzycki Wojciech , Kuśmierczyk Mariusz , Kwinecki Paweł , Markuszewski Leszek , Maruszewski Bohdan , Missima Maurycy , Moll Jacek J , Ogorzeja Wojciech , Pająk Jacek , Pasierski Michał , Pawliszak Wojciech , Pietrzyk Edward , Religa Grzegorz , Rogowski Jan , Różański Jacek , Sadowski Jerzy , Sharma Girish , Skalski Janusz , Skiba Jacek , Stanisławski Ryszard , Stążka Janusz , Stec Sebastian , Stępiński Piotr , Suwalski Grzegorz , Suwalski Kazimierz , Suwalski Piotr , Tułecki Łukasz , Widenka Kazimierz , Wierzba Waldemar , Wojtalik Michał , Woś Stanisław , Zembala Michał Oskar , Żelazny Piotr 
Published: January 2024

Abstract

OBJECTIVES
The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both.

METHODS
A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure.

RESULTS
Initially, 42 510 patients with preoperative AF were identified, and, after exclusion, 33 949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27 437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P &lt; 0.001). Mortality benefits were reflected when stratified by surgery type with the exception of aortic valve surgery where LAAO alone fare worse than no treatment.

CONCLUSIONS
Among patients with preoperative AF undergoing cardiac surgery, surgical management of AF, particularly SA + LAAO, was associated with lower 6-year mortality. These findings support the benefits of incorporating SA and LAAO in the management of AF during cardiac surgery.