Surgical Ablation Boosts Survival in CABG Patients

A new study in The Annals of Thoracic Surgery, published by The Society of Thoracic Surgeons, reveals that Medicare patients with atrial fibrillation (AF) who receive surgical ablation during isolated coronary artery bypass grafting (CABG) have improved survival compared with those who do not. These findings strongly support existing clinical guidelines that recommend the procedure, guidelines that are frequently overlooked in practice.

Researchers conducted a retrospective analysis of Medicare data that examined 87,699 beneficiaries with preexisting atrial fibrillation who underwent CABG, with or without concomitant surgical ablation, between 2008 and 2019. The study assessed all-cause mortality and stroke incidence as distinct outcomes. To account for measured confounding factors, overlap propensity score weighting was applied. Additionally, surgeon ablation frequency was used as an instrumental variable to address potential unmeasured confounding.

Among the 87,699 Medicare beneficiaries with atrial fibrillation who underwent CABG, 19,384 (22.2%) received concomitant surgical ablation. During the study period, 1,193 surgeons rarely performed ablation (<5%; treating 16,242 patients), 1,834 performed it occasionally (≥5% but <40%; 55,820 patients), and 652 performed it frequently (≥40%; 15,637 patients).

In the as-treated analysis, patients who received surgical ablation had a risk-adjusted median survival benefit of 4.40 months (95% CI, 2.40-6.36 months; 7.82 years; 95% CI, 7.65-7.98 vs 7.46 years; 95% CI, 7.38-7.57; P<0.001) compared with those who did not. In the provider-preference analysis, patients treated by surgeons who frequently performed ablation had a risk-adjusted median survival benefit of 4.96 months (95% CI, 2.10-7.82 months; 7.03 years; 95% CI, 6.90-7.20 vs 6.62 years; 95% CI, 6.46-6.79; P<0.001) compared with those treated by surgeons who performed it infrequently.

“In Medicare beneficiaries with preexisting atrial fibrillation, concomitant surgical ablation during CABG is associated with improved survival, as is undergoing CABG by a surgeon who frequently ablates. Our findings support current guidelines recommending surgical ablation during CABG in patients with atrial fibrillation and highlight that ablation is currently underused in contemporary practice,” the researchers concluded.