Surgical ablation for atrial fibrillation: risk factors for recurrence and long-term outcome

Objectives Atrial fibrillation (AF) is the most common cardiac arrhythmia. Due to the insufficient efficacy of antiarrhythmic drugs and their adverse side effects, there has been considerable interest in the interventional treatment of AF, including both catheter ablation and surgical ablation. Surgical ablation or "maze procedure" is a treatment option for patients with AF undergoing concomitant or isolated cardiac surgery. Design We performed a retrospective study of prospectively collected data. This study aimed to investigate short- and long-term outcomes of patients who underwent the surgical ablation of AF. Outcomes variables include freedom from recurrent atrial arrhythmias and mortality at 1- 3- 5- and 7-year follow-up. We also identify risk factors for arrhythmia recurrences and mortality. Setting Israel's largest university tertiary care center. Participants The study population included 668 patients, operated between 01.01.2006 and 30.06.2022. All data of patients were extracted from our departmental database. Interventions Concomitant or stand-alone surgical AF ablation. Measurements and Main Results The mean follow-up duration was 106 ± 66.7 months. Freedom from atrial fibrillation was 97.6% (615 patients). Mortality was 3% (20 patients) after a 1-year follow-up, 95.3% (574 patients), and 6.1% (45 patients) after a 3-year follow-up, 90.1% (396 patients) and 9.1% (61 patients) after a 5-year follow-up, and 77.5% (308 patients) and 10.8% (72 patients) after 7-year follow-up respectively. According to logistic regression analysis, age and female gender determined the 7-year recurrence of AF. The risk factors for 7-year mortality were diabetes mellitus, age and valvular surgery Conclusion Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1- 3- 5- and 7-years follow-up. Age and female gender were factors that determined the 5- and 7-year recurrence of AF.