PMID- 32791060
OWN - NLM
STAT- MEDLINE
DCOM- 20210309
LR  - 20210309
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 111
IP  - 3
DP  - 2021 Mar
TI  - Safety of Atrial Fibrillation Ablation With Isolated Surgical Aortic Valve 
      Replacement.
PG  - 809-817
LID - S0003-4975(20)31297-2 [pii]
LID - 10.1016/j.athoracsur.2020.06.015 [doi]
AB  - 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.
CI  - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Churyla, Andrei
AU  - Churyla A
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois. Electronic address: andrei.churyla@nm.org.
FAU - Andrei, Adin-Cristian
AU  - Andrei AC
AD  - Department of Preventative Medicine, Division of Biostatistics, Northwestern 
      University, Chicago, Illinois.
FAU - Kruse, Jane
AU  - Kruse J
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois.
FAU - Cox, James L
AU  - Cox JL
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois.
FAU - Kislitsina, Olga N
AU  - Kislitsina ON
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois.
FAU - Liu, Menghan
AU  - Liu M
AD  - Bluhm Cardiovascular Institute Clinical Trials Unit, Northwestern University, 
      Chicago, Illinois.
FAU - Malaisrie, S Chris
AU  - Malaisrie SC
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois.
FAU - McCarthy, Patrick M
AU  - McCarthy PM
AD  - Division of Cardiac Surgery, Northwestern University, Northwestern Memorial 
      Hospital, Chicago, Illinois.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20200811
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2021 Mar;111(3):817-818. PMID: 33058820
MH  - Aged
MH  - Aortic Valve/*surgery
MH  - Atrial Fibrillation/complications/*surgery
MH  - Catheter Ablation/methods
MH  - Female
MH  - Heart Valve Diseases/complications/*surgery
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Illinois/epidemiology
MH  - Male
MH  - Postoperative Complications/*mortality
MH  - *Propensity Score
MH  - Risk Factors
EDAT- 2020/08/14 06:00
MHDA- 2021/03/10 06:00
CRDT- 2020/08/14 06:00
PHST- 2020/01/24 00:00 [received]
PHST- 2020/06/01 00:00 [revised]
PHST- 2020/06/08 00:00 [accepted]
PHST- 2020/08/14 06:00 [pubmed]
PHST- 2021/03/10 06:00 [medline]
PHST- 2020/08/14 06:00 [entrez]
AID - S0003-4975(20)31297-2 [pii]
AID - 10.1016/j.athoracsur.2020.06.015 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2021 Mar;111(3):809-817. doi: 10.1016/j.athoracsur.2020.06.015. 
      Epub 2020 Aug 11.