Factors associated with maintenance of sinus rhythm after surgical ablation in patients with concomitant atrial fibrillation: a systematic review and meta-analysis

Objective: The treatment efficacy of surgical ablation in patients with atrial fibrillation (AF) remains controversial. It is currently difficult to identify what kinds of AF patients may benefit most from this surgical strategy. The present meta-analysis systematically reviewed relevant clinical trials to identify the factors that affect sinus rhythm maintenance after surgical AF ablation (SAFA). Methods: From their inception to Mar 2015, the trials that discuss multiple risk factor interventions for sinus rhythm maintenance after SAFA were retrieved from the MEDLINE, PubMed, Cochrane Library, and EMBASE databases. Study characteristics included 11 factors related to the demographics, cardiac conditions, cardiac morbidity, and comorbidities. Results: According to the inclusion and exclusion criteria, 11 trials that involved 1099 patients were screen out from 2431 studies for meta-analysis. Of the 12 potential risk factors, 3 showed significant associations with sinus rhythm maintenance and AF recurrence, i.e., duration of AF (mean difference: 2.05; 95% confidence interval: 0.29-3.80; P=0.0005), left atrial diameter (mean difference: 6.24; 95% confidence interval: 4.85-7.62; P< 0.0001), and tricuspid valve disease (odds ratio: 2.95; 95% confidence interval: 1.66-5.23; P=0.0002). Other factors had no significant associations with sinus rhythm maintenance. Conclusions: Duration of AF, left atrial diameter, and tricuspid valve disease are the main factors affecting sinus rhythm maintenance after SAFA. Patients with long-standing AF, large left atrial diameter, and/or tricuspid valve disease are more likely to fail in sinus rhythm maintenance and suffer from recurrent AF after SAFA.