Concomitant Atrial Fibrillation Ablation in Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

BACKGROUND

Atrial fibrillation (AF) is common in patients undergoing surgical aortic valve replacement; however, surgical ablation remains underused due to limited data on its efficacy.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.