Medical Student McMaster University St. Catharines, Ontario, Canada
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with long-term morbidity and mortality. Cardiac surgery presents the opportunity to perform ablation for AF, a procedure aimed at restoring sinus rhythm that has been shown to improve long-term outcomes. Surgical ablation of AF is endorsed in clinical guidelines. However, only about 43% of eligible patients receive concomitant surgical ablation during cardiac surgery. This study aimed to understand the variability in the adoption of surgical ablation of AF among cardiac surgeons and to identify factors influencing the decision to perform the procedure.
METHODS AND RESULTS: The survey included items designed to assess respondents’ demographic characteristics. For those who perform ablation, additional questions explored the methods used and decision-making factors. For non-performers, the survey examined perceived barriers to performing ablation. The instrument was piloted to ensure clarity, eliminate redundancy, and incorporate feedback. A convenience sample was drawn from cardiac surgeons involved in LeAAPS and LAAOS III trials. The survey was distributed electronically and anonymized using REDCap and all statistical analyses were conducted using Python (3.12.8). Of the 362 surveys distributed, 79 were completed (22% response rate). After excluding three incomplete responses, 76 surveys were included in the final analysis. 47% of respondents were based in North America, 45% in Europe, 5% in Oceania, and 3% in South America. Respondents reported a mean of 22 (SD 10) years in practice and an average annual surgical volume of 190 (SD 73) cases. 63% of respondents reported a primary focus on coronary artery bypass grafting, and 62% on aortic valve procedures. Majority of respondents (67/76, 88%) reported performing surgical ablation of AF. Based on respondents’ reported likelihood of performing AF ablation in patients with AF, notable deterrents included the following clinical factors: increased left atrial size, more persistent forms of AF, more severe left ventricular dysfunction, reoperation, minimally invasive surgeries, and complex cases with long pump times (Figure 1). Among non-performing surgeons (9/76, 12%), common factors reported to increase future adoption of AF ablation included stronger clinical evidence and more affordable and accessible equipment.
Conclusion: Our findings reveal that while surgical ablation of AF is commonly performed by our survey respondents, variation exists in how and when it is used by cardiac surgeons. This supports the need for a well-designed, definitive trial to guide future care and address the gap between recommendations and practice.
