Surgical Ablation Concomitant with Non-mitral valve surgery for Persistent Atrial Fibrillation

Abstract Background Consensus regarding an optimal atrial fibrillation (AF) ablation lesion set concomitant with aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) has not been established. Methods We enrolled 125 consecutive patients (70±8 years old, 89 males) with persistent AF who underwent radiofrequency-based pulmonary vein isolation (PVI) (PVI group, n=53) or a Cox-Maze procedure (Maze group, n=72) with AVR and/or CABG. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent Cox Maze with and those who underwent PVI, we established weighted Cox proportional-hazards regression models with inverse-probability-of-treatment weighting (IPTW). Mean follow-up was 63±34 months (maximum, 154 months). Results There was 1 in-hospital mortality in each group. Patients who underwent Cox-Maze showed a higher freedom from AF at all follow-up examinations. Following surgery, there were 32 deaths, 13 thromboembolisms, 8 hemorrhagic events, and 22 heart failure readmissions. The Maze group had higher rates for 5-year survival (88% vs. 64%, p=0.013) and freedom from composite events (74% vs. 42%, p Conclusions In patients with persistent AF indicated for non-mitral valve surgery, a concomitant Cox-Maze procedure resulted in superior AF- and event-free survival as compared to PVI without increased risk of early mortality. These findings may assist decision making for surgical management of persistent AF concomitant with AVR and/or CABG.