Polat Emre, Kharbanda Rohit K, Ghafar Moustafa, Schoones Jan W, Klautz Robert J M, de Riva Marta, Palmen Meindert, Girdauskas Evaldas, Tomšič Anton
Department of Cardiothoracic Surgery, Augsburg University Medical Centre, Augsburg, Germany.
Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
CJC Open. 2025 May 13;7(7):887-896. doi: 10.1016/j.cjco.2025.05.001. eCollection 2025 Jul.
Atrial fibrillation (AF) is common in patients undergoing surgical aortic valve replacement; however, surgical ablation remains underused due to limited data on its efficacy.
We conducted a systematic review of the literature by searching PubMed, Embase, Web of Science, Emcare, and the Cochrane Library for studies reporting outcomes of concomitant surgical AF ablation in patients undergoing surgical aortic valve replacement. The primary outcomes included freedom from AF recurrence, overall survival, and complications. We analyzed outcomes using traditional meta-analysis at specific time points, alongside pooled Kaplan-Meier curves.
Nine studies were included, encompassing a total of 12,683 patients. Concomitant ablation reduced the risk of postoperative AF but increased the risk of permanent pacemaker implantation (risk ratio 1.36, 95% confidence interval [CI] 1.16-1.60, < 0.01) and postoperative renal failure (RR 1.38, 95% CI 1.11-1.71, < 0.01). During follow-up, concomitant ablation effectively restored and maintained sinus rhythm, with up to 80% of patients remaining free from recurrent AF 2-4 years post-surgery. Moreover, improved late survival was observed with concomitant ablation (unadjusted hazard ratio 0.84, 95% CI 0.73-0.96, = 0.013).
Surgical ablation during surgical aortic valve replacement was effective in restoring and maintaining sinus rhythm after surgery. Preoperative rhythm status may play an important role in guiding treatment plans, potentially enhancing the clinical outcomes for patients scheduled for aortic valve intervention.
心房颤动（AF）在接受外科主动脉瓣置换术的患者中很常见；然而，由于其疗效的数据有限，手术消融的应用仍然不足。
我们通过检索PubMed、Embase、Web of Science、Emcare和Cochrane图书馆对文献进行了系统评价，以寻找报告接受外科主动脉瓣置换术的患者同时进行外科房颤消融结果的研究。主要结局包括无房颤复发、总生存率和并发症。我们在特定时间点使用传统荟萃分析以及汇总的Kaplan-Meier曲线分析结局。
纳入9项研究，共12683例患者。同时进行消融降低了术后房颤的风险，但增加了永久性起搏器植入的风险（风险比1.36，95%置信区间[CI]1.16-1.60，P<0.01）和术后肾衰竭的风险（RR 1.38，95%CI 1.11-1.71，P<0.01）。在随访期间，同时进行消融有效地恢复并维持了窦性心律，术后2-4年高达80%的患者无房颤复发。此外，观察到同时进行消融可改善晚期生存率（未调整的风险比0.84，95%CI 0.73-0.96，P=0.013）。
外科主动脉瓣置换术中的手术消融在术后恢复和维持窦性心律方面有效。术前心律状态可能在指导治疗方案中起重要作用，可能改善计划接受主动脉瓣干预患者 的临床结局。
