Surgical ablation for treatment of atrial fibrillation in cardiac surgery: a cumulative meta-analysis of randomised controlled trials

Introduction: Concomitant surgical ablation is a treatment modality for patients with atrial fibrillation (AF) undergoing cardiac surgery, however, its efficacy and clinical outcomes are not well established. The present study is the first cumulative meta-analysis of randomised controlled trials (RCT) on clinical outcomes of surgical ablation versus no ablative treatment in all patients with cardiac surgery. Methods: Electronic searches were performed using six databases from their inception to October 2013, identifying all relevant RCTs comparing surgical ablation versus no ablation in patients with AF undertaking cardiac surgery. Data were extracted and analysed according to predefined clinical endpoints. Results: Sixteen relevant RCTs were identified for the present study. Higher prevalence of sinus rhythm in the surgical ablation group was evident at all ≥12 month follow-up (OR, 6.72; 95% CI 4.88 to 9.25; p<0.00001). There were no significant differences between surgical ablation versus no ablation in terms of mortality (OR, 1.05; 95% CI 0.66 to 1.68; p=0.83), pacemaker implantations (OR, 0.88; 95% CI 0.51 to 1.51; p=0.64), and neurological events (OR, 0.86; 95% CI 0.37 to 2.04; p=0.74). Cumulative meta-analysis demonstrated that these trends have remained consistent over the years, with recent studies narrowing the CIs of the summary estimates. Conclusions: The evaluation of the current randomised trials demonstrates that concomitant surgical ablation and cardiac surgery is safe and effective at restoring sinus rhythm.