Kowalewski Mariusz, Dąbrowski Emil Julian, Kurasz Anna, Święczkowski Michał, Raffa Giuseppe Maria, Kawczyński Michał, Aerts Luca, Kuźma Łukasz, Wańha Wojciech, Batko Jakub, Litwinowicz Radosław, Urbanowicz Tomasz, Stec Sebastian, Lorusso Roberto, Hanke Thorsten, Maesen Bart, Meani Paolo, Ronco Daniele, Pilato Michele, Musumeci Francesco, McCarthy Patrick, Cox James L, Pannone Luigi, Merino Jose L, Pürerfellner Helmut, Badhwar Vinay, La Meir Mark, de Asmundis Carlo, Lip Gregory Y H, Suwalski Piotr
Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), Maastricht, The Netherlands.
Eur J Cardiothorac Surg. 2025 Jul 1;67(7). doi: 10.1093/ejcts/ezaf187.
Patients with preoperative atrial fibrillation (AF) undergoing cardiac surgery face a heightened risk of complications and reduced survival. Concomitant surgical ablation (SA) has shown promise in mitigating the arrhythmic burden, prompting guideline upgrades by major scientific societies. However, SA remains underutilized, with performance rates varying between 22% and 48%, depending on the type of procedure. The goal of this narrative review is to summarize current evidence to aid physicians in decision making regarding AF management during cardiac surgery. This review examines existing literature on the prevalence, management and outcomes of AF in cardiac surgery. We assess epidemiological data, summarize trends in clinical practice and review the rationale and techniques for treating AF surgically. Emerging challenges, including barriers to implementation and novel therapeutic advancements, are also discussed. Evidence underscores the detrimental impact of preoperative AF on perioperative and long-term outcomes, including higher mortality, morbidity and thromboembolic risk. Concomitant SA, particularly the Cox-maze IV procedure, significantly improves sinus rhythm restoration, reduces mortality and mitigates complications like stroke. However, the procedure remains underperformed due to concerns about complexity, prolonged operative time and training gaps. Emerging hybrid techniques, novel mapping systems and technologies like pulsed field ablation may enhance outcomes and broaden SA adoption. Concomitant SA is an effective yet underutilized therapy that can improve survival and reduce AF-related complications in cardiac surgery patients. Addressing implementation barriers and integrating advancements in technology and surgical approaches are key to optimizing patient outcomes.
接受心脏手术的术前房颤（AF）患者面临更高的并发症风险和更低的生存率。同期手术消融（SA）已显示出减轻心律失常负担的前景，促使主要科学学会对指南进行更新。然而，SA的应用仍未得到充分利用，其实施率在22%至48%之间，具体取决于手术类型。本叙述性综述的目的是总结当前证据，以帮助医生在心脏手术期间就房颤管理做出决策。本综述研究了关于心脏手术中房颤的患病率、管理和结局的现有文献。我们评估流行病学数据，总结临床实践趋势，并回顾手术治疗房颤的基本原理和技术。还讨论了新出现的挑战，包括实施障碍和新的治疗进展。证据强调术前房颤对围手术期和长期结局的不利影响，包括更高的死亡率、发病率和血栓栓塞风险。同期SA，尤其是Cox迷宫IV手术，可显著改善窦性心律恢复，降低死亡率，并减轻中风等并发症。然而，由于对复杂性、手术时间延长和培训差距的担忧，该手术的实施情况仍然不佳。新出现的混合技术、新型标测系统以及脉冲场消融等技术可能会改善结局并扩大SA的应用。同期SA是一种有效但未得到充分利用的治疗方法，可提高心脏手术患者的生存率并减少与房颤相关的并发症。解决实施障碍并整合技术和手术方法的进展是优化患者结局的关键。
