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Ablation of atrial fibrillation during coronary artery bypass grafting: Late outcomes in a Medicare population.

Authors
  • Malaisrie, S Chris1
  • McCarthy, Patrick M2
  • Kruse, Jane2
  • Matsouaka, Roland A3
  • Churyla, Andrei2
  • Grau-Sepulveda, Maria V4
  • Friedman, Daniel J4
  • Brennan, J Matthew4
  • 1 Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Northwestern Memorial Hospital, Chicago, Ill. Electronic address: [email protected]
  • 2 Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Northwestern Memorial Hospital, Chicago, Ill.
  • 3 Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
  • 4 Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC.
Type
Published Article
Journal
The Journal of thoracic and cardiovascular surgery
Publication Date
Apr 01, 2021
Volume
161
Issue
4
Identifiers
DOI: 10.1016/j.jtcvs.2019.10.159
PMID: 31952824
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study compares outcomes of patients with preoperative atrial fibrillation undergoing coronary artery bypass grafting (CABG) with or without concomitant atrial fibrillation ablation in a nationally representative Medicare cohort. This study examined early and late outcomes in CABG patients with a preoperative history of atrial fibrillation to determine the correlation between surgical atrial fibrillation ablation to mortality and stroke or systemic embolization. In the Medicare-linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated CABG from 2006 to 2013; 34,600 (9.6%) had preoperative atrial fibrillation; 10,541 (30.5%) were treated with surgical ablation (ablation group), and 23,059 were not (no ablation group). Propensity score matching was performed using a hierarchical mixed model. Long-term survival was summarized using Kaplan-Meier curves and Cox regression models with robust variance estimation. The stroke or systemic embolization incidence was modeled using the Fine-Gray model. Median follow-up was 4 years. Long-term mortality in propensity score-matched CABG patients (mean age 74 years; Society of Thoracic Surgeons risk score, 2.25) receiving ablation versus no ablation was similar (log-rank P = .30). Stroke or systemic embolization occurred in 2.2% versus 2.1% at 30 days and 9.9% versus 12.0% at 5 years (Gray P = .0091). Landmark analysis from 2 to 5 years showed lower mortality (hazard ratio, 0.89; 95% confidence interval 0.82-0.97; P = .0358) and lower risk of stroke or systemic embolization (hazard ratio, 0.73; 95% confidence interval, 0.61-0.87; P = .0006) in the ablation group. Concomitant ablation in CABG patients with preoperative atrial fibrillation is associated with lower stroke or systemic embolization and mortality in patients who survive more than 2 years. Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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