title: Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database.
abstract: BACKGROUND
  We used The Society of Thoracic Surgeons National Cardiac Database to document the utilization of surgical atrial fibrillation (AF) correction procedures in North America. We also examined the subset of patients having mitral valve surgery to determine whether concurrent surgical AF correction procedures were associated with an increased risk of morbidity or mortality.
  
  
  METHODS
  Retrospective review of outcomes for 67,389 patients with AF having cardiac surgery between January 2004 and December 2006 was conducted. Multivariable logistic regression was performed to assess whether concomitant AF correction procedures increased risk in the mitral valve surgery cohort.
  
  
  RESULTS
  Overall, 38% (25,718 of 67,389) of patients with AF undergoing cardiac surgery had an AF correction procedure, increasing from 28.1% in 2004 to 40.2% in 2006. Surgical AF correction was performed in 52% (6,415 of 12,235) of mitral valve surgery patients, 28% (2,965 of 10,590) of those having aortic valve surgery, and 24% (5,438 of 22,388) of those having isolated coronary artery bypass grafting. After adjusting for differences in preoperative characteristics, mitral valve surgery patients with a surgical AF correction procedure did not have a significantly higher risk of mortality (adjusted odds ratio, 1.00; 95% confidence interval, 0.83 to 1.20) or major morbidity. The risk for new permanent pacemaker implantation was higher (adjusted odds ratio, 1.26; 95% confidence interval, 1.07 to 1.49) in the AF correction with mitral valve surgery group.
  
  
  CONCLUSIONS
  Although a growing number of patients with AF are treated with concurrent AF correction procedures during cardiac surgery, nearly 60% of patients are left untreated. Among patients with AF and mitral valve disease, the addition of an AF correction procedure does not increase perioperative morbidity or mortality.
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jgammie@smail.umaryland.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: Michel
authors.initials: M
authors.lastname: Haddad
authors.forename: Sarah
authors.initials: S
authors.lastname: Milford-Beland
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies