Concomitant Atrial Fibrillation Surgery for People Undergoing Cardiac Surgery

Summary

A Cochrane review[Abstract] 1 included 22 studies with a total of 1 899 subjects. The studies assessed the effects of concomitant atrial fibrillation (AF) surgery among people with AF who were undergoing cardiac surgery for other underlying reasons; mitral valve surgery was the most common primary cardiac surgery (86%). Concomitant atrial fibrillation surgery (cut-and-sew maze, radiofrequency ablation, cryoablation, or high-intensity focused ultrasound with or without left atrial appendage excision or ligation) was compared with no AF surgery.

There was no difference in all-cause mortality between individuals who underwent AF surgery and those who did not, but AF surgery increased freedom from atrial fibrillation, atrial flutter (AFL), or atrial tachycardia (AT) off antiarrhythmic medications > 3 months after surgery. The rate of adverse of events defined by investigators were not routinely reported but were not different between the two groups. The only individual adverse event that appeared higher in the intervention group was the need for permanent pacemaker implantation (table T1).

There was uncertainty of any effect of concomitant AF surgery on cardiovascular mortality, other adverse events, fatal or non-fatal cardiovascular events, neurological or thromboembolic events, or health-related quality of life. Data on costs and cost-effectiveness were infrequently reported. One study reported results on costs and cost-effectiveness of AF surgery. The authors estimated that AF surgery costs an additional 74 724 € and was not considered cost-effective with an incremental cost-effectiveness ratio of 73 359 € per quality adjusted life year based on results from the EuroQoL instrument.