Long-term survival and stroke after cardiac surgery with concomitant surgical ablation for atrial fibrillation

Background: Concomitant surgical ablation (SA) is recommended at the time of cardiac surgery in patients with AF but it remains widely underperformed. We sought to report on the safety and long-term efficacy of concomitant SA and the associated incidence of stroke and survival. Methods: A retrospective observational study was performed on patients with AF undergoing cardiac surgery between April 2011 and March 2022 with grouping based on whether or not they received concomitant SA. Thirty-day complications and long-term atrial tachyarrhythmia recurrence, stroke and mortality were compared between groups after propensity score matching. Results: A total of 1,205 patients were included; two groups were obtained after matching (n=326 each). Post-operative length of stay was slightly longer in matched patients receiving concomitant SA (median 10 versus 9 days; p=0.048) but length of stay on intensive care and complication rates were similar in both groups. Freedom from atrial tachyarrhythmia in the SA group was 74% at 1 year and 58% at 3 years compared with 10% and 8%, respectively, for the no-SA group. Ten-year survival was increased for matched patients in the SA group compared with patients in the no-SA group (adjusted HR 0.61; 95% CI [0.45–0.82]; p=0.001) but the incidence of ischaemic stroke was similar (subdistribution HR 1.11; 95% CI [0.53–2.30]; p=0.790). Conclusion: In patients with AF undergoing cardiac surgery, concomitant SA was associated with improved long-term survival without increasing complications. Concomitant SA was not associated with an independent reduction in the long-term incidence of ischaemic stroke.