Effect of Surgical Atrial Fibrillation Ablation at the Time of Cardiac Surgery on Risk of Postoperative Pacemaker Implantation.
The aim of this study was to retrospectively investigate whether performing surgical atrial fibrillation (AF) ablation in conjunction with cardiac surgery (CS) increases the risk for postoperative permanent pacemaker (PPM) requirement. The 30-day risk for PPM requirement was analyzed in consecutive patients who underwent CS from January 2007 to August 27, 2013. Patients were divided into 3 groups: (1) those who underwent AF ablation concomitant with CS (AF ABL), (2) patients with any history of AF who underwent surgery who did not undergo ablation (AF NO ABL), and (3) those with no histories of AF who underwent surgery (NO AF). Logistic regression analysis was performed adjusting for age, gender, and surgery type. Of 13,453 CS patients, 353 (3%) were in the AF ABL group, 1,701 (12%) in the AF NO ABL group, and 11,399 (85%) in the NO AF group. A total of 7,651 patients (57%) underwent coronary artery bypass grafting, 4,384 (33%) underwent valve surgery, and 1,418 (10%) underwent coronary artery bypass grafting and valve surgery. The overall PPM risk was 1.6% (212 of 13,453); risk was 5.7% (20 of 353) in the AF ABL group, 3.1% (53 of 1,701) in the AF NO ABL group, and 1.2% (139 of 11,399) in the NO AF group. The unadjusted and adjusted odds of PPM were higher in the AF ABL and AF NO ABL groups than in the NO AF group (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7 to 4.4, and adjusted OR 1.7, 95% CI 1.2 to 2.4, respectively). The unadjusted OR comparing the AF ABL group and the AF NO ABL group was significant (unadjusted OR 1.9, 95% CI 1.9 to 3.2); however, the OR adjusted for surgery type, age, and gender showed a trend toward significance (adjusted OR 1.6, 95% CI 0.9 to 2.7). In conclusion, in this large cohort of patients who underwent CS, surgical AF ablation appeared to carry an increased risk for postoperative PPM implantation.
Division of Cardiology, Department of Medicine, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: melcham@emory.edu.
Mikhael F
MF
El-Chami
Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia.
José Nilo G
JN
Binongo
Department of Medicine, Emory Healthcare, Atlanta, Georgia.
Mathew
M
Levy
Division of Cardiology, Department of Medicine, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Faisal M
FM
Merchant
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Michael
M
Halkos
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Vinod
V
Thourani
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Omar
O
Lattouf
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Robert
R
Guyton
Division of Cardiothoracic Surgery, Department of Surgery, Mount Sinai University, New York, New York.
John
J
Puskas
Division of Cardiology, Department of Medicine, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia.
Angel R
AR
Leon
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D017115:Catheter Ablation; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011182:Postoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States