Abstract 16747: Surgical Atrial Fibrillation Ablation: a Systematic Review and Meta-analysis of Randomized Controlled Trials
Background: Surgical ablation for atrial fibrillation (AF) significantly improves maintenance of sinus rhythm and is recommended as a concomitant procedure in patients undergoing cardiac surgery. Current trials lack power to assess for patient-important outcomes such as mortality, stroke and pacemaker requirement. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of surgical AF ablation.
Methods: We searched Cochrane CENTRAL, MEDLINE and EMBASE from inception to May 2016 for RCTs evaluating surgical AF ablation using any lesion set versus no surgical AF ablation in adults with AF undergoing cardiac surgery. We performed screening, full-text eligibility assessment, risk of bias evaluation and data collection independently and in duplicate. We evaluated the risk of bias for individual studies with the modified Cochrane tool, overall quality of evidence with the GRADE framework and pooled data using a random effects model in Revman 5.3.
Results: We identified 22 studies (n=1839) meeting eligibility criteria. Surgical AF ablation was associated with more freedom from AF at 12 months (RR 2.35, 95% CI [1.92 to 2.88], p<0.001, I2 = 46%, low quality). However, no significant difference was seen in mortality (RR 1.02, 95% CI [0.72 to 1.47], I2= 0%, moderate quality), stroke (RR 1.19, 95% CI [0.59 to 2.39], p=, 0.63, I2=0% moderate quality) and pacemaker implantation (RR 1.27, 95% CI [0.82 to 1.98], p=0.28, I2= 3%, high quality).
Comparing biatrial and left sided lesion sets, no significant difference was seen in freedom from AF at 12 months (p=0.12), mortality (p =0.39) or stroke (p=0.15). Biatrial procedures conferred an increased risk of pacemaker requirement (RR 2.72, 95%CI[1.37 to 5.37], p=0.004, I2=0%) while left sided lesion sets did not (RR 1.08, 95%CI[0.66 to 1.78], p=0.75, I2=6%). This difference was significant (p for interaction=0.03).
Conclusion: Surgical AF ablation during cardiac surgery improved freedom from AF on follow-up. However patient-important outcomes including mortality and stroke did not differ. Biatrial when compared to left sided lesion sets showed no difference in freedom from AF, mortality or stroke but was associated with a significantly increased risk of pacemaker requirement.
Author Disclosures: G.R. McClure: None. E.P. Belley-Cote: None. R.K. Singal: None. I. Jaffer: None. N. Dvirnik: None. K.R. An: None. G. Fortin: None. J. Spence: None. R.P. Whitlock: None.
- © 2016 by American Heart Association, Inc.