Clinical benefits of concomitant surgical ablation for atrial fibrillation in patients undergoing mitral valve surgery

doi:10.1016/j.hrthm.2022.09.014

Clinical benefits of concomitant surgical ablation for atrial fibrillation in patients undergoing mitral valve surgery

Heart RhythmPublished 22 Sep 2022Retrospective cohort study

Main finding · Composite of death, cerebrovascular accident and major bleedingResultHazard ratio 0.799 95% CI 0.731–0.873

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Authors' conclusion

The addition of the maze procedure during MV surgery provided protective effects in the composite outcome of interest.

Study context

Population: Patients with atrial fibrillation (AF) undergoing mitral valve (MV) surgery, South Korean national claims database, 2009–2017
Participants: 9,501 patients3,376 matched pairs

Exposure: Concomitant maze procedure vs no maze during MV surgery
Mazen = 5,508
Outcome: Composite of:
Death
Cerebrovascular accident
Major bleeding

Methodological detailspropensity-score matched, national health claims database

Propensity-score matched
National health claims database

Main finding

As reported in the abstract

Hazard ratio

0.799

95% CI 0.731–0.873

Mazevs Nonmaze

HR 0.799 (95% CI 0.731–0.873)

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with maze ←→ Higher risk with maze →	HR (95% CI)
Death, ischemic stroke, hemorrhagic strokeMazevs NonmazeDeath	0.512	0.795 (0.711–0.889)
Death, ischemic stroke, hemorrhagic strokeMazevs NonmazeIschemic stroke	0.512	0.788 (0.67–0.926)
Death, ischemic stroke, hemorrhagic strokeMazevs NonmazeHemorrhagic stroke	0.512	0.984 (0.768–1.262)
	0.512Hazard ratio (log scale)

Composite outcome, by subgroup (age ≥70 or <70 years, replacement vs repair, MV pathology, CHA2DS2-VASc ≥4 or <4)

Benefits consistent across subgroups

Safety

Outcome	← Lower risk with maze ←→ Higher risk with maze →	HR (95% CI)
Major bleeding	0.512	0.749 (0.627–0.895)
	0.512Hazard ratio (log scale)

Original publication

Clinical benefits of concomitant surgical ablation for atrial fibrillation in patients undergoing mitral valve surgery. Heart Rhythm. Published 22 September 2022. doi:10.1016/j.hrthm.2022.09.014

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