The German Cardiosurgery Atrial Fibrillation Registry: 1-Year Follow-up Outcomes

Visual Abstract Key question What results are achieved after surgical ablation by atrial fibrillation in Germany? Key findings At 1-year follow-up, significant improvement in symptoms was reported. Arrythmia monitoring needs to be optimized. Take-home message Surgical ablation provides symptomatic relief in patients with atrial fibrillation. Cardiac arrhythmia motoring remains a challenge. Objectives This study of German Cardiosurgery Atrial Fibrillation (CASE-AF) registry aims to describe the 1-year outcomes of patients undergoing ablative procedures for atrial fibrillation (AF) in a cardiosurgical setting. Methods Between January 2017 and April 2020, 17 German cardiosurgical units enrolled 1,000 consecutive patients undergoing concomitant or stand-alone ablation for AF. In-hospital and 1-year follow-up data were collected on web-based electronic case report forms. The protocol mandated telephone-based follow-up contact after 1 year. Results At 1-year follow-up (median, 14.5 months [12.6-18.2 months]), significant improvement ( p < 0.0001) in baseline modified European Heart Rhythm Association Class I was reported in both concomitant and stand-alone patients. Follow-up examinations were completed in 97.9% of cases, and a sinus rhythm was reported in 60.2 and 63.6% of stand-alone and concomitant patients, respectively. Statistically significant factors determining late recurrence were female gender ( p = 0.013), preoperative persistent AF ( p < 0.0001), and presence of cardiac implantable electronic device ( p = 0.011). All-cause mortality at 1 year was 1% ( n = 1) in stand-alone patients and 6.7% ( n = 58) in concomitant patients. Conclusion Surgical ablation of AF is safe and provides satisfactory results at short-term follow-up, with significant improvement in patient symptoms. Adequate cardiac rhythm monitoring should be prioritized for higher quality data acquisition.