Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study
Open accessAbstract
AIMS: Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes. METHODS AND RESULTS: This multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n = 117) vs. group B (no ablation, n = 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2% of group A patients vs. 35.5% in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3% (group A) vs. 14.7% (group B, P = 0.411). All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P = 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9%, P < 0.001). CONCLUSION: Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later.
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Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.
“Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.[461][462][463][464]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [461]
The Cox maze procedure and other forms of atrial fibrillation surgery have mainly been used in patients undergoing other open heart surgical procedures.
“The Cox maze procedure and other, often simpler, forms of AF surgery have mainly been used in patients undergoing other open heart surgical procedures.461,466,[784][785][786][787][788][789][790][791][792][793][794][795][796][797][798]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [461]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation: A Systematic Review
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- Authors
- Budera, P., Straka, Z., Osmancik, P., Vanek, T., Jelinek, S., Hlavicka, J., Fojt, R., Cervinka, P., Hulman, M., Smid, M., Maly, M., & Widimsky, P.
- Affiliations
- Charles University (CZ)
- National Institute of Cardiovascular Diseases (SK)
- Corresponding author
- Budera, P.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-08-28
- Volume
- 33
- Issue
- 21
- Pages
- 2644-2652
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC3485575
- OpenAlex
- W2099755014
- Cited by
- 154
- References
- 38
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 13 · 2023: 5 · 2022: 14 · 2021: 10 · 2020: 11 · 2019: 10 · 2018: 18 · 2017: 20 · 2016: 13 · 2015: 7 · 2014: 9 · 2013: 8 · 2012: 4
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Univerzita Karlova v Praze (MSM 0021620817, UNCE 204010)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, cardiac surgery, sinus rhythm restoration, coronary artery disease, valvular heart disease, postoperative outcomes, stroke, mortality, paroxysmal atrial fibrillation, persistent atrial fibrillation
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Coronary Disease, Electrocardiography, Female, Heart Valve Diseases, Humans, Male, Postoperative Care, Postoperative Complications, Prospective Studies, Recurrence, Treatment Outcome, Catheter Ablation, Operative Time
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