ICC - Mid-term Survival After Concomitant Surgical Ablation Vs. Second Arterial Conduit In Cabg Patients With Atrial Fibrillation

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Mid-term Survival After Concomitant Surgical Ablation Vs. Second Arterial Conduit In Cabg Patients With Atrial Fibrillation
Jakub Braczkowski, Michal Pasierski, Mariusz Kowalewski, Piotr Suwalski.
National Medical Institute of the Ministry of Interior, Warsaw, Poland.

Objective: Atrial fibrillation (AF) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG), contributing to increased long-term mortality. While both concomitant surgical ablation and the use of multiple arterial grafts have been proposed to improve outcomes, comparative data on their relative survival benefit in this population are limited. This study aimed to evaluate whether surgical ablation or use of a second arterial conduit (in addition to the left internal mammary artery [LIMA]) is associated with superior survival in AF patients undergoing isolated CABG. Methods: We performed a retrospective registry analysis of patients undergoing isolated CABG. Patients undergoing redo surgery, treated in the emergency setting with single-vessel disease, or who did not receive a LIMA graft were excluded. Two patient groups were identified: (1) those receiving LIMA plus one or more vein grafts with surgical ablation; and (2) those receiving LIMA plus one or more additional arterial grafts without AF treatment. Results: After exclusions, 1326 patients were included, 443 in group 1 and 883 in group 2. 1:2 propensity score matching was used to adjust for baseline differences, resulting in 314 well balanced cohort triplets. The primary endpoint was all-cause mortality with a median follow-up of 4.6 years. Cox proportional hazards modeling showed significantly better survival in the surgical ablation group (Hazard Ratio: 0.77, Confidence Intervals [0.60 - 0.99], p= 0.047).Conclusions: In patients with AF undergoing CABG, surgical ablation was associated with greater long-term survival than use of a second arterial conduit. These findings support incorporating AF ablation in surgical planning for this population.

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