title: Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study.
abstract: OBJECTIVE
  Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes.
  
  
  RESULTS
  This multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n = 117) vs. group B (no ablation, n = 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2% of group A patients vs. 35.5% in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3% (group A) vs. 14.7% (group B, P = 0.411). All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P = 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9%, P < 0.001).
  
  
  CONCLUSIONS
  Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later.
authors.affiliation: Cardiocenter, Third Faculty of Medicine, Charles University Prague, Czech Republic. budera@atlas.cz
authors.forename: Petr
authors.initials: P
authors.lastname: Budera
authors.forename: Zbyněk
authors.initials: Z
authors.lastname: Straka
authors.forename: Pavel
authors.initials: P
authors.lastname: Osmančík
authors.forename: Tomáš
authors.initials: T
authors.lastname: Vaněk
authors.forename: Štěpán
authors.initials: Š
authors.lastname: Jelínek
authors.forename: Jan
authors.initials: J
authors.lastname: Hlavička
authors.forename: Richard
authors.initials: R
authors.lastname: Fojt
authors.forename: Pavel
authors.initials: P
authors.lastname: Červinka
authors.forename: Michal
authors.initials: M
authors.lastname: Hulman
authors.forename: Michal
authors.initials: M
authors.lastname: Šmíd
authors.forename: Marek
authors.initials: M
authors.lastname: Malý
authors.forename: Petr
authors.initials: P
authors.lastname: Widimský
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants