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Abstract
OBJECTIVES
The CArdioSurgEry Atrial Fibrillation (CASE-AF) registry is a prospective, multicentre study for collecting and analysing real-world data of surgical atrial fibrillation (AF) treatment. This study aimed to evaluate outcomes of surgery for long-standing persistent AF at 1 year.
METHODS
In total, 17 centres consecutively include all eligible patients with continuous AF lasting for ≥1 year. Exclusion criteria are missing informed consent or age <18 years. For patient-reported outcomes measures, the European Heart Rhythm Association score was used. No presence of AF (based on ECG findings including Holter ECG and/or implanted devices), no re-ablation, no further cardioversion and no rehospitalization due to AF after a 3-month blanking period defined no AF recurrence at 1 year.
RESULTS
From January 2017 to January 2020, a total of 1115 patients were enrolled in CASE-AF. Of them, 202 patients (mean age 69.7 ± 7.8 years, 27.2% female) underwent surgical ablation of long-standing persistent AF (study cohort), mostly accompanied by left atrial appendage closure (n = 180 [89%], resection n = 75 [42%]) and predominantly performed as concomitant (n = 174 [86%]) and left atrial only procedure (n = 144 [71%]). Early mortality (30 days) was 2.0% and morbidity was low. At follow-up (median 14.4 months, interquartile range, 12.7–17.6 months, 100% complete), 106 patients (56%) had no AF recurrence and 93% of them were asymptomatic. AF recurrence was accompanied by AF-related rehospitalization (n = 12, P = 0.003), direct current shock cardioversion (n = 23, P < 0.001), AF ablation (n = 7, P = 0.003) and stroke (n = 3, P = 0.059). Multivariable analysis identified cryoablation, predominantly performed endocardially including additional left atrial (74%) and biatrial (42%) lesions, as a significant factor for freedom from AF recurrence (odds ratio 2.7, 95% confidence interval 1.07–6.79, P = 0.035).
CONCLUSIONS
According to CASE-AF, surgical ablation of long-standing persistent AF is most effective when concomitantly performed using endocardial cryoablation. Ongoing follow-up allows further elucidation of efficacious treatment strategies.
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Details
1 Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) , Berlin, Germany
2 Institut für Herzinfarktforschung , Ludwigshafen, Germany
3 Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde , Bad Rothenfelde, Germany
4 Department of Cardiac Surgery, Herzzentrum Dresden GmbH Universitätsklinik an der Technischen Universität Dresden , Dresden, Germany
5 Department of Cardiology, Internistisches Klinikum München Süd , München, Germany
6 Department of Cardiac Surgery, München Klinik Bogenhausen , München, Germany
7 Department of Cardiovascular Surgery, Universitätsklinikum Gießen , Gießen, Germany
8 Department of Cardiac Surgery, Krankenhaus der Barmherzigen Brüder , Trier, Germany
9 Department of Cardiac Surgery, Asklepios Klinikum Harburg , Hamburg, Germany