Surgical ablation of long-standing persistent atrial fibrillation: 1-year outcomes from the CArdioSurgEry Atrial Fibrillation (CASE-AF) registry

Grubitzsch, Herko; Caliskan, Etem; Ouarrak, Taoufik; Senges, Jochen; Doll, Nicolas; Knaut, Michael; Lewalter, Thorsten; Eichinger, Walter; Niemann, Bernd; Friedrich, Ivar; Hanke, Torsten; Falk, Volkmar; ,; Hanke, Thorsten; Lewalter, Thorsten; Senges, Jochen; Grubitzsch, Herko; Caliskan, Etem; Ouarrak, Taoufik; Knaut, Michael; Eichinger, Walter; Niemann, Bernd; Friedrich, Ivar; Falk, Volkmar; Wehbe, Mahmoud; Albert, Marc; Vondran, Maximilian; Ghazy, Tamer; Warnecke, Henning; Doss, Mirko; Liebold, Andreas; Eszlari, Edgar; Rastan, Ardawan; Mitrovic, Ivana; Cvorak, Adi; Fischlein, Theodor; Sack, Falk-Udo; Hindricks, Gerd; Doll, Nicolas

doi:10.1093/icvts/ivad203

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…Data were collected by eCRF, developed by the IHF. Data collection was organized as previously described [20,21]. The completeness of the 12 months follow-up for the LRP group was performed in 366 of the 376 patients (completeness: 97.3%) and was performed for the HRP group in 586 of the 606 patients (completeness: 96.7%).…”

Section: Data Collectionmentioning

confidence: 99%

Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Niemann,

Doll,

Grubitzsch

et al. 2024

Thorac Cardiovasc Surg

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Background: Surgical atrial ablation is evaluated by surgeons in relation to the estimated surgical risk. We analyze whether high-risk patients experience risk escalation by ablation procedures. Methods: The Case AF Registry is a prospective, multicenter, all-comers registry of atrial ablation in cardiac surgery. We analyzed the 1-year outcome regarding survival and rhythm endpoints of 1000 consecutive patients according to the operative risk classification (EuroscoreII ≤2 versus >2). Results: Higher NYHA score, ischemic heart failure, status post-stroke, renal insufficiency, COPD and diabetes mellitus were strongly represented in high-risk-patients (HRP). HRP exhibit more LVEF<40% (19.2 vs. 8.8%; p<0.001), but identical LA diameter and LVEDD compared to Low-risk-patients (LRP). CHA2DS-Vasc-score (2.4±1 vs. 3.6±1.5; p<0.001), sternotomies, combination surgeries, CABG, mitral valve procedures were increased in HRP. LRP underwent stand-alone ablations as well. Ablation energy did not differ. LAA closure was performed in up to 86.1% (mainly cut-and-sew-procedures). Mortality corresponded to the original risk class without an escalation that may be related to ablation, stroke rate or myocardial infarction. 60.6% of HRP vs 75.1% of LRP were discharged in sinus- rhythm. Longterm EHRA–SCORE symptoms were lower in HRP. Repeated rhythm therapies were rare. Additional antiarrhythmics recieved a minority without group dependency. 1.6 vs. 4.1%(HRP) p=0.042, underwent long-term-stroke, excess mortality was not observed. Anticoagulation remained common in HRP. Conclusion: Surgical risk and long-term-mortality is determined by the underlying disease. In HRP freedom from atrial fibrillation and symptom relief can be achieved. Pre-operative risk scores should not lead to withholding an ablation procedure.

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Section: Data Collectionmentioning

confidence: 99%

Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Niemann,

Doll,

Grubitzsch

et al. 2024

Thorac Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

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Impact of Preoperative Sinus Rhythm on Concomitant Surgical Ablation’s One-Year Success in Patients with Atrial Fibrillation: A Prospective Registry Cohort Study

Vondran,

Ghazy,

Choi

et al. 2024

JCM

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Background: The surgical ablation (SA) of atrial fibrillation (AF) during cardiac surgery is performed in only 8–40% of patients. We performed a subgroup analysis of the 1-year follow-up from the German CArdioSurgEry Atrial Fibrillation (CASE-AF) registry to determine how preoperative sinus rhythm (SR) prior to SA affected the outcomes. Methods: The CASE-AF registry enrolled AF patients scheduled for cardiac surgery with concomitant SA. The in-hospital and one-year follow-up data were collected prospectively and analyzed retrospectively. Results: From September 2016 to August 2020, 964 patients were enrolled in the CASE-AF registry. Among them, 333 patients were in SR immediately before surgery (study cohort). A complete follow-up was achieved for 95.6%. Both the severity of the AF (modified European Heart Rhythm Association symptom classification, p < 0.001) and the frequency of AF symptoms (p = 0.006) were significantly reduced at one year compared to the preoperative baseline. Almost 90 percent of the patients underwent left atrial appendage occlusion (LAAO) during the procedure. The one-year mortality (4.1%) and stroke rates (3.2%) were low. SR was evident in 70.3% of the patients at the one-year follow-up. Conclusions: Patients with AF who have SR at the time of surgery should not be excluded from SA, as it appears to be a safe and effective procedure.

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Surgical ablation of long-standing persistent atrial fibrillation: 1-year outcomes from the CArdioSurgEry Atrial Fibrillation (CASE-AF) registry

Cited by 2 publications

References 24 publications

Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Surgical Ablation of Atrial Fibrillation in High-Risk Patients: Success versus Risk

Impact of Preoperative Sinus Rhythm on Concomitant Surgical Ablation’s One-Year Success in Patients with Atrial Fibrillation: A Prospective Registry Cohort Study

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