Surgical Ablation During CABG Linked to Enhanced Patient Survival

A recent study published in The Annals of Thoracic Surgery highlights a significant relationship between surgical ablation and improved survival rates in Medicare patients diagnosed with atrial fibrillation (AF) who undergo coronary artery bypass grafting (CABG). The findings advocate for adherence to clinical guidelines that recommend this procedure, which remains underutilized despite its potential benefits.

Researchers analyzed Medicare claims data involving over 87,000 patients with pre-existing AF who underwent CABG from 2008 to 2019. The study revealed that merely 22% of these patients received concomitant surgical ablation during their CABG procedures. Although there was an increase in the rate of ablation over the years, only 27% of patients had undergone the procedure by 2019, which followed a Class I recommendation from the Society of Thoracic Surgeons advocating for ablation.

The results indicated that surgical ablation was associated with a risk-adjusted median survival advantage of 4.4 months compared to patients who did not receive the ablation (7.82 years versus 7.46 years; P<0.001). Furthermore, patients operated on by surgeons who frequently performed ablation experienced a median survival advantage of nearly five months compared to those treated by surgeons who rarely conducted the procedure (7.03 years versus 6.62 years; P<0.001).

The lead researcher emphasized that this study adds to a growing body of evidence suggesting that surgical ablation can significantly enhance survival for patients with pre-existing AF undergoing CABG. The analysis suggested that the benefits of surgical ablation may manifest over a prolonged period, potentially due to a reduced incidence of tachycardia-related heart failure, which contributes to improved long-term survival rates.

To account for potential biases, the researchers employed advanced statistical methods. One approach, overlap propensity score weighting, adjusted for measurable differences among patients, while another, a surgeon-preference instrumental variable analysis, compared outcomes between patients treated by surgeons with different ablation frequencies. This methodology simulates randomization effects by leveraging variations in clinical practices among surgeons, thus balancing unmeasured patient differences.

Between 10% and 20% of patients undergoing CABG have AF prior to surgery, a condition linked to both perioperative complications and diminished long-term survival. Prior studies have indicated that surgical ablation can restore normal heart rhythms and enhance long-term outcomes, yet the procedure remains underutilized.

The authors of the study stress the importance of adhering to established guidelines and hope that these findings will prompt a re-evaluation of surgical decision-making for patients diagnosed with AF.

For further details, please refer to the study: Justin M. Schaffer et al, Survival After Surgical Ablation of Atrial Fibrillation During Coronary Artery Bypass in Medicare Beneficiaries, The Annals of Thoracic Surgery (2025). DOI: 10.1016/j.athoracsur.2025.03.044