Our Summary

This study discusses the potential benefits of surgically treating atrial fibrillation (AF), a type of irregular heartbeat, at the same time as other heart surgeries. This combined treatment approach is recommended, but not often used, especially when patients are having coronary artery bypass grafting (CABG) or aortic valve surgery.

The research shows that when AF is treated during these surgeries, patients have a better chance of returning to a normal heartbeat and better long-term results. Large observational studies have shown that this approach can improve quality of life and increase survival rates, as well as reduce the risk of strokes. This potential benefit has not been recognized by the Society of Thoracic Surgery or American Association for Thoracic Surgery.

The study also emphasizes the importance of closing the left atrial appendage, a small pouch in the heart, as part of the AF treatment. This step significantly reduces the risk of stroke after heart surgery and improves the success rate of the AF treatment. The researchers provide updated recommendations on the surgical techniques for AF treatment and its effects on patient health before, during, and after surgery.

FAQs

  1. What are the benefits of treating atrial fibrillation (AF) during other heart surgeries?
  2. Why is closing the left atrial appendage important in AF treatment during heart surgery?
  3. What are the updated recommendations on surgical techniques for AF treatment during heart surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cardiac surgery is to discuss with their surgeon the option of treating atrial fibrillation (if present) during the surgery, especially if they are already undergoing other heart surgeries such as CABG or aortic valve surgery. This combined treatment approach can improve long-term outcomes, quality of life, and reduce the risk of strokes. Additionally, closing the left atrial appendage during the surgery can further decrease the risk of stroke. It is important for patients to be informed about these potential benefits and to have open communication with their healthcare team about their treatment options.

Suitable For

Patients who are typically recommended for cardiac surgery are those with severe coronary artery disease, valve disease, heart failure, or arrhythmias such as atrial fibrillation. In particular, patients undergoing coronary artery bypass grafting (CABG) or aortic valve surgery may benefit from receiving treatment for atrial fibrillation during their surgery. These patients may have a higher risk of stroke or other complications if their irregular heartbeat is not addressed during surgery.

Overall, patients who have a higher risk of stroke, heart failure, or other complications related to their heart condition may be recommended for cardiac surgery. It is important for patients to discuss their individual risk factors and treatment options with their healthcare provider to determine if cardiac surgery is the best course of action for them.

Timeline

  • Before surgery: The patient may have been experiencing symptoms of AF, such as palpitations, shortness of breath, and fatigue. They undergo tests to diagnose the condition and determine the best course of treatment. In the case of combined surgery for AF and another heart condition, the patient and their healthcare team discuss the risks and benefits of treating both conditions simultaneously.

  • During surgery: The patient undergoes the planned heart surgery, whether it be CABG, aortic valve surgery, or another procedure, along with the treatment for AF. The surgeon may use various techniques to restore normal heart rhythm and close the left atrial appendage.

  • After surgery: The patient is closely monitored in the hospital for complications and recovery. They may receive medications to manage pain, prevent infection, and reduce the risk of blood clots. Follow-up appointments are scheduled to assess healing, monitor heart function, and adjust medications as needed. With successful treatment of AF during surgery, the patient has a better chance of returning to a normal heartbeat, improving their quality of life, and reducing the risk of complications such as strokes.

What to Ask Your Doctor

  1. What are the potential benefits of treating atrial fibrillation during my planned heart surgery?

  2. How common is it for AF to be treated during surgeries like CABG or aortic valve surgery?

  3. What are the long-term outcomes for patients who have AF treated during heart surgery compared to those who do not?

  4. Are there any specific criteria that need to be met in order to have AF treated during my planned surgery?

  5. What are the risks associated with treating AF during heart surgery?

  6. What surgical techniques will be used to treat my AF during the procedure?

  7. How will treating AF during my heart surgery impact my recovery process?

  8. Will closing the left atrial appendage as part of the AF treatment be beneficial for me?

  9. Are there any additional follow-up procedures or medications I will need to take after having AF treated during my surgery?

  10. Are there any guidelines or recommendations from professional medical societies regarding treating AF during heart surgeries that I should be aware of?

Reference

Authors: Churyla A, Desai A, Kruse J, Cox J, McCarthy P. Journal: J Cardiovasc Electrophysiol. 2020 Aug;31(8):2172-2178. doi: 10.1111/jce.14408. Epub 2020 Mar 10. PMID: 32096258