Long-Term Results of Left Atrial Appendage Amputation in Patients Undergoing Concomitant AF Ablation during Cardiac Surgery

Objectives: To evaluate whether amputation of the left atrial appendage (LAA) during concomitant atrial fibrillation (AF) ablation in patients undergoing cardiac reduces the rate of strokes and improves freedom from AF in the long term.

Methods: From October 2010 to December 2017, a total of 466 consecutive patients (mean age: 72 ± 7.7 years, 322 males) underwent AF ablation as a concomitant procedure during cardiac surgery.

Surgical procedures were mainly isolated CABG (n = 192), isolated mitral valve surgery (n = 61), isolated aortic valve surgery (n = 42) and other combined procedures (n = 171). Before surgery, 237 patients were diagnosed with paroxysmal AF. In 198 of these patients, only left atrial ablations were performed. In 163 of 229 patients with persistent AF, biatrial ablations were performed. During the 7-year time frame, the lesion sets were defined and similar in all patients. All patients had an event recorder (Medtronic Reveal XT) implanted during surgery.

A LAA amputation (LAAa) was performed in 270 patients, the LAA was left in place in 92 patients.

Result: Mean follow-up time was 2.5 ± 2.3 years, and follow-up completeness was 93.9%. During the observation period, 28 patients (6.0%) were lost to follow-up, and 136 patients (29%) died.

There were no significant differences in overall freedom from AF among patients who underwent LAA amputation versus preserved (47.8 vs. 55.8%, p = 0.75) at latest follow-up. Stroke rate was 2.9% in the LAAa group, and 4.4% in the LAAp group (p = 0.47). Twenty-one patients (10%) received a new pacemaker over time.

Only 54 patients (19%) were not anticoagulated (LAAa: 21%, LAAp: 12%), whereas 130 patients (46%) received warfarin (LAAa: 49%, LAAp: 37%), and 101 patients (35%) received DOAKs (LAAa: 30%, LAAp: 51%).

Conclusion: LAA amputation during cardiac surgery in patients with AF did not lower the incidence of postoperative stroke significantly. Patients are often on oral anticoagulation even when the LAA was amputated and they are free from AF.

Publication History

Article published online:
19 February 2021