Left atrial concomitant surgical ablation for treatment of atrial fibrillation in cardiac surgery: A meta-analysis of randomized controlled trials

<div><p>Introduction</p><p>Surgical ablation is a generally established treatment for patients with atrial fibrillation undergoing concomitant cardiac surgery. Left atrial (LA) lesion set for ablation is a simplified procedure suggested to reduce the surgery time and morbidity after procedure. The present meta-analysis aims to explore the outcomes of left atrial lesion set versus no ablative treatment in patients with AF undergoing cardiac surgery.</p><p>Methods</p><p>A literature research was performed in six database from their inception to July 2017, identifying all relevant randomized controlled trials (RCTs) comparing left atrial lesion set versus no ablative treatment in AF patient undergoing cardiac surgery. Data were extracted and analyzed according to predefined clinical endpoints.</p><p>Results</p><p>Eleven relevant RCTs were included for analysis in the present study. The prevalence of sinus rhythm in ablation group was significantly higher at discharge, 6-month and 1-year follow-up period. The morbidity including 30 day mortality, late all-cause mortality, reoperation for bleeding, permanent pacemaker implantation and neurological events were of no significant difference between two groups.</p><p>Conclusions</p><p>The result of our meta-analysis demonstrates that left atrial lesion set is an effective and safe surgical ablation strategy for AF patients undergoing concomitant cardiac surgery.</p></div

Lesion set description of included studies.

<p>Lesion set description of included studies.</p

Summary of RCTs comparing CS+LA versus CS surgical treatment in patients with AF/.

<p>Summary of RCTs comparing CS+LA versus CS surgical treatment in patients with AF/.</p

Forest plot of neurological events, showing summary ORs with 95% confidence intervals for included studies.

<p>Forest plot of neurological events, showing summary ORs with 95% confidence intervals for included studies.</p

Forest plot of late mortality, showing summary ORs with 95% confidence intervals for included studies.

<p>Forest plot of late mortality, showing summary ORs with 95% confidence intervals for included studies.</p

Forest plot of sinus rhythm prevalence at discharge, 6-month, and 1 year follow-up, showing summary of ORs with 95% confidence intervals for included studies.

<p>Forest plot of sinus rhythm prevalence at discharge, 6-month, and 1 year follow-up, showing summary of ORs with 95% confidence intervals for included studies.</p

Summary of baseline patient characteristics and risk factors in studies comparing CS+LA with CS alone in surgical treatment for atrial fibrillation.

<p>Summary of baseline patient characteristics and risk factors in studies comparing CS+LA with CS alone in surgical treatment for atrial fibrillation.</p

Meta-regression analysis assessing the effect of various patient characteristics on sinus rhythm at discharge.

<p>LVEF: left ventricular ejection fraction; LAD: left atrial diameter.</p

Search strategy of meta-analysis for left atrial surgical ablation with cardiac surgery (CS + LA) versus cardiac surgery (CS) alone in atrial fibrillation (AF) patients.

<p>Search strategy of meta-analysis for left atrial surgical ablation with cardiac surgery (CS + LA) versus cardiac surgery (CS) alone in atrial fibrillation (AF) patients.</p

Forest plot of 1-year freedom from atrial fibrillation at 1 year follow-up, showing summary of HRs with 95% confidence intervals for included studies.

<p>Forest plot of 1-year freedom from atrial fibrillation at 1 year follow-up, showing summary of HRs with 95% confidence intervals for included studies.</p