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Effect of Concomitant Surgical Atrial Fibrillation Ablation in Patients with Reduced Left Ventricle Ejection Fraction: A Propensity‐Score Matching Analysis
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  • Goran Rimac,
  • Nicolas Lauzon,
  • Mario Sénéchal,
  • François Dagenais,
  • Frederic Jacques,
  • François Philippon,
  • Pierre Voisine
Goran Rimac
Institut universitaire de cardiologie et de pneumologie de Quebec

Corresponding Author:rimacgoran@gmail.com

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Nicolas Lauzon
Institut universitaire de cardiologie et de pneumologie de Quebec
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Mario Sénéchal
Institut universitaire de cardiologie et de pneumologie de Quebec
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François Dagenais
Institut universitaire de cardiologie et de pneumologie de Quebec
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Frederic Jacques
Institut universitaire de cardiologie et de pneumologie de Quebec
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François Philippon
Institut universitaire de cardiologie et de pneumologie de Quebec
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Pierre Voisine
Institut universitaire de cardiologie et de pneumologie de Quebec
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Abstract

Background: Atrial fibrillation (AF) is common in patients with reduced left ventricle ejection fraction (RLVEF). The impact of concomitant surgical atrial fibrillation ablation (SAFA) in patients with RLVEF is uncertain. The purpose of this study was to assess the outcomes of concomitant SAFA in patients with RLVEF undergoing heart surgery on heart failure (HF) rehospitalization and mortality. Methods: Using a local registry and electronic health records linked with provincial civil register survival data from July 2002 to April 2019, we analyzed treatment and outcomes in a cohort of patients with AF and HF defined by left ventricle ejection fraction (LVEF) ≤ 40%. Health records were used to collect treatment and International Classification of Diseases (ICD 10) codes to determine outcomes. A negative binomial model was used to compare outcomes such as all-cause mortality and rehospitalization for heart failure. Results: The cohort included 682 patients with RLVEF and AF who underwent coronary artery bypass graft and/or valve surgery. A total of 196 patients (29%) underwent concomitant SAFA. After matching, 132 patients with concomitant SAFA were compared to 159 patients who did not undergo concomitant SAFA. At 6.0±3.7 years of follow-up, concomitant SAFA was not associated with lower all-cause mortality (P=0.9861) and reduction in rehospitalizations for heart failure decompensation (P=0.31) compared to patients who did not have concomitant SAFA performed. Post-operatively, concomitant SAFA might be associated with less vasopressor and mechanical support use (p=0.01). Conclusions: Concomitant SAFA during index cardiac surgery is safe but does not reduce mortality or rehospitalizations for HF. The effects of concomitant SAFA in the context of RLVEF needs to be better studied with prospective trials.
04 Apr 2022Submitted to Journal of Cardiac Surgery
04 Apr 2022Submission Checks Completed
04 Apr 2022Assigned to Editor
05 Apr 2022Reviewer(s) Assigned
26 Apr 2022Review(s) Completed, Editorial Evaluation Pending
26 Apr 2022Editorial Decision: Revise Major
26 May 20221st Revision Received
26 Jul 2022Submission Checks Completed
26 Jul 2022Assigned to Editor
31 Jul 2022Reviewer(s) Assigned
14 Aug 2022Review(s) Completed, Editorial Evaluation Pending
14 Aug 2022Editorial Decision: Accept
Nov 2022Published in Journal of Cardiac Surgery volume 37 issue 11 on pages 3598-3606. 10.1111/jocs.16927