Concomitant Atrial Fibrillation Procedures During Septal Myectomy: An STS Database Analysis

In this analysis of the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, involving 3,579 patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy between 2014 and 2023, patients with atrial fibrillation (AF) had more comorbidities and worse outcomes than those without. However, among patients with AF, concomitant surgical ablation (performed in 55 percent, usually with left atrial appendage occlusion) showed no increase in operative mortality, stroke, pacemaker implantation, renal failure, or 30-day readmission vs no ablation after propensity matching. These findings support concomitant AF ablation with appendage occlusion as a reasonable consideration during septal myectomy.