Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, Ill.
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
J Thorac Cardiovasc Surg. 2020 Jun;159(6):2245-2253.e15. doi: 10.1016/j.jtcvs.2019.06.062. Epub 2019 Jul 10.
Surgical ablation for atrial fibrillation concomitant with cardiac surgery is now a Class I recommendation for selected patients. Understanding how the revised recommendations will affect appropriate use of surgical ablation is challenging because the reported prevalence of preoperative atrial fibrillation depends on the definition used. The objective was to determine the prevalence of atrial fibrillation in the 3 years before cardiac surgery and the rate of concomitant surgical ablation.
Patients with and without a diagnosis of atrial fibrillation in the 3 years before surgical coronary artery bypass, aortic valve replacement, or mitral valve replacement/repair were identified in the 2014 Medicare Standard Analytical File.
Patients had prior atrial fibrillation in 28.4% of 79,134 cardiac surgeries. Prior atrial fibrillation was associated with risk factors for increased cardiac surgical morbidity/mortality, including recent heart failure, renal failure, and lung disease. Black patients were less likely to have prior atrial fibrillation but more likely to have had infrequent care for it. Isolated coronary artery bypass had the lowest prevalence but highest absolute number of prior atrial fibrillation cases. Concomitant surgical ablation was performed in 22.1% of patients with prior atrial fibrillation. Patients with mitral valve surgery were 3-fold more likely to receive surgical ablation. Women were less likely to have prior atrial fibrillation but less likely to have surgical ablation when they did.
Medicare beneficiaries had a substantially higher prevalence of atrial fibrillation diagnoses in the 3 years before cardiac surgery than previously published rates of preoperative atrial fibrillation. Concomitant surgical ablation was performed in less than one-quarter of patients with atrial fibrillation undergoing cardiac surgery for other indications.
对于某些特定患者，心脏手术联合房颤的外科消融术目前是 I 类推荐。理解这些修订建议将如何影响外科消融术的合理应用具有挑战性，因为术前房颤的报告发生率取决于所使用的定义。本研究旨在确定心脏手术前 3 年内房颤的发生率和同期外科消融术的比例。
在 2014 年 Medicare 标准分析文件中，确定了在外科冠状动脉旁路移植术、主动脉瓣置换术或二尖瓣置换/修复术前 3 年内有或无房颤诊断的患者。
79134 例心脏手术中，有 28.4%的患者术前存在房颤。术前房颤与增加心脏手术发病率/死亡率的危险因素相关，包括近期心力衰竭、肾衰竭和肺部疾病。黑人患者发生房颤的可能性较低，但接受房颤治疗的频率较低。单纯冠状动脉旁路移植术的房颤发生率最低，但有房颤病史的绝对病例数最高。有房颤病史的患者中，有 22.1%接受了同期外科消融术。行二尖瓣手术的患者接受外科消融术的可能性是其 3 倍。女性发生房颤的可能性较低，但如果发生房颤，接受外科消融术的可能性也较低。
与之前发表的术前房颤发生率相比，医疗保险受益人的心脏手术前 3 年房颤诊断率明显更高。对于因其他指征行心脏手术合并房颤的患者，同期行外科消融术的比例不足四分之一。
