Efficacy of surgical ablation and left atrial appendage occlusion in patients with AF undergoing coronary artery bypass grafting: A network meta-analysis

Abstract

Background

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that greatly elevates the risk of stroke. This risk increases both during and after cardiac procedures, such as coronary artery bypass grafting (CABG). There is an increasing interest in non-pharmacological treatments such as left atrial appendage occlusion (LAAO) and surgical ablation, intending to enhance both immediate and long-term postoperative results.

Objective

To investigate the efficacy of surgical ablation (SA), LAAO, or both in patients with AF undergoing CABG.

Methods

We searched four electronic databases: PubMed, Scopus, Cochrane Library, and WOS. We analyzed data using R language and “netmeta” and “netrank” packages of meta-insight software. Pooled outcomes were reported as mean difference or risk ratio (RR) with 95 % confidence interval (CI) in a random effect method.

Results

A total of 16 studies were included with 594,312 patients included. The 30-day mortality showed a non-statistically significant difference between CABG-LAAO compared to CABG alone and CABG-SA with RR of 1.70 (95%CI 0.38–7.61) and 0.62 (95%CI 0.10–3.94). However, compared to CABG alone, CABG-SA + LAAO, CABG-LAAO, and CABG-SA had significantly lower risk of long-term mortality with RR 0.75 (95%CI 0.57–0.98), 0.78 (95%CI 0.65–0.94), and 0.73 (95%CI 0.61–0.88), respectively. CABG-SA + LAAO, CABG-LAAO, and CABG-SA reduced the risk of short-term stroke compared to CABG alone with RR of 0.73 (95%CI 0.43–1.24), 0.93 (95%CI 0.78–1.11), and 1.01 (95%CI 0.75–1.36), respectively. Moreover, only CABG-SA + LAAO and CABG-LAAO showed a statistically significant reduction in long term stroke and hospitalization due to heart failure while CABG-SA showed no statistically significant difference. Furthermore, there was no statistically significant difference between our interventions in terms of 30-day rehospitalization, intra-aortic balloon pump support, and risk of hemorrhage.

Conclusion

Among patients with AF undergoing CABG, whether undergoing SA alone or LAAO alone or both showed significant clinical outcomes such as reduced risk of both short- and long-term mortality and short-term stroke.