Atrial Fibrillation Survival Better With Cardiac Surgery, Cox-Maze IV

ACC AHA Atrial Fibrillation Flutter Guidelines
ACC AHA Atrial Fibrillation Flutter Guidelines
Patients with atrial fibrillation had improved late survival when treated with ablation-assisted Cox-Maze IV and cardiac surgery.

Patients who have atrial fibrillation or AFib treatment with ablation-assisted Cox-Maze IV procedure (CM4) in addition to cardiac surgery experience improved late survival compared with patients who are untreated, according to a retrospective study published in the Journal of Thoracic and Cardiovascular Surgery.1

Investigators retrospectively reviewed patients with AF who underwent cardiac surgery and concomitant CM4 (n=438). They also compared this group with patients with AF who underwent cardiac surgery and no CM4 (n=1510), as well as patients who underwent cardiac surgery without AF (n=8911).

After a Kaplan-Meier analysis, the investigators found patients with AF who underwent both cardiac surgery and CM4 had better survival compared with patients with untreated AF (P =.004). At 10 years, survival was higher in the concomitant CM4 groups compared with untreated AF (62% vs 42%, respectively; hazard ratio, 0.47; 95% CI, 0.26-0.86, P =.014).

There was no difference between the matched groups (CM4 and cardiac surgery vs cardiac surgery and no AF) with regard to 30-day mortality (3% vs 3%, respectively; P =1.000). In terms of 10-year survival, no differences were observed between the CM4 and no-AF patient groups (63% vs 55%, respectively; adjusted hazard ratio, 1.03; 95% CI, 0.51-2.11; P =.929).

Because of its retrospective design, this study may contain inherent biases that might be overcome in a prospective, blinded trial. In addition, the investigators commented that patients selected for concomitant CM4 in this study were initially healthier than untreated patients with AF, potentially contributing to the survival benefits associated with cardiac surgery and additional therapy.

Despite these limitations, the late survival benefit found after cardiac surgery and concomitant CM4 “should encourage surgeons to treat AF at the time of surgery in appropriate patients.”

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Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery [published online September 27, 2017]. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2017.09.095