Does Concomitant Surgical Atrial Fibrillation Ablation Increase Immediate and Early Risk of Mitral Surgery?

Objective: Concomitant surgical ablation of atrial fibrillation (AF) is well-established method with up to 90% of patients in sinus rhythm after the procedure. Unfortunately, many patients with AF undergoing mitral surgery do not undergo concomitant ablation of arrhythmia. We feel that the reason for that is a surgeon`s perception that a concomitant ablation can add some risk for the patient in immediate and early perioperative period. We tried to estimate this risk in our patients.

Methods: Between January 2004 and July 2015 we performed on 591 patients only mitral ± tricuspid valve surgery and on 170 patents we performed mitral ± tricuspid valve surgery with concomitant surgical AF ablation. Because preoperative and operative parameters of these groups were not equal we used propensity score matching method analyzing more than 30 parameters, including age, gender, functional class, comorbidities, mitral and tricuspid pathology, ventricular function, pulmonary hypertension etc. We ended with 136 matched cases in each group.

Results: We found that ICU stay and ventilation time, hospitalization length, hospital mortality and adverse events like postoperative low cardiac output, dialysis, strokes and transient ischemic attacks and even permanent pacemaker implantation were similar in patients undergoing concomitant surgical ablation of AF to patients that undergo mitral ± tricuspid valve surgery without ablation.

Conclusions: Concomitant surgical atrial fibrillation ablation does not increase immediate and early risk of mitral valve surgery and should be strongly considered in patients with atrial fibrillation.