CONCOMITANT SURGERY FOR ATRIAL FIBRILLATION AND ISCHEMIC HEART DISEASE
Atrial fibrillation is associated with high risk of all-cause mortality and morbidity. Despite the actual guidelines recommending management of atrial fibrillation, such as surgical ablation at the time of coronary artery bypass surgery, most patients with atrial fibrillation and coronary artery disease do not receive concomitant surgical ablation. This review reports the modern experience of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass. Extended meta-analysis includes Russian and worldwide studies reporting outcomes of concomitant atrial fibrillation surgical ablation and coronary artery bypass grafting between January 2000 and March 2020. Thirteen studies exclusively reported outcomes of surgical ablation in patients undergoing coronary artery bypass, whereas the remaining twelve reported outcomes of concomitant cardiac surgery with subgroup analysis. Only four studies performed the concomitant Cox maze procedure, data reports improved efficiency in management of atrial tachyarrhythmia in patients with comorbidity. Freedom from atrial tachyarrhythmia was reported as high as 98% at 1 year and 76% at 5 years with Cox maze procedure, whereas lesser lesion sets had more variable outcomes, ranging from 35% to 93%. In the review the addition of surgical ablation was not associated with increased morbidity and mortality. The results indicate the feasibility of widespread use of combined technique of surgical ablation and coronary artery bypass grafting in clinical practice.