Rankin JS, et al. - This study describes the clinical outcomes and costs associated with surgical ablation (SA) in patients with prior atrial fibrillation (AF) undergoing coronary artery bypass grafting (CABG). Data reported that in 2013, 17% of CABG-AF patients underwent SA, in the US Medicare population. SA did not result in an increase in the operative risks for mortality and stroke but it raised the costs. Notably, SA provided significantly better risk-adjusted late survival.

Methods

• Researchers divided a total of 3745 Medicare beneficiaries with prior AF who underwent CABG in 2013, into 2 groups: those with and those without concomitant SA.
• They compared risk-adjusted early (0–90 days) and late (91–364 days) postoperative outcomes and inpatient costs.

Results

• Findings revealed that SA was performed in 17% of CABG patients with prior AF.
• According to data, following preoperative characteristics favoured patients with SA: emergent presentation (15% vs 22%), heart failure in the 2 weeks prior to CABG (31% vs 36%), chronic lung disease (27% vs 33%) and renal failure (4% vs 7%) (all P < 0.05).
• Researchers observed that the risk-adjusted operative mortality and perioperative stroke rates were similar in the 2 groups.
• They also noted that the risk-adjusted survival was similar through 90 days, but significantly better with SA after 90 days [hazard ratio (HR) = 0.58; P = 0.03].
• Data also reported that, at 1 year, the risk-adjusted incidence of cardiovascular implantable electronic device implantation was greater with SA (HR = 1.20; P = 0.01).
• In addition, findings demonstrated that risk-adjusted costs for the CABG admission (HR = 1.11; P < 0.01) and inpatient care through 1 year (HR = 1.06; P = 0.02) were also greater with SA.