Surgical Ablation, Left Atrial Appendage Occlusion, or Both? Nationwide Registry Analysis of Cardiac Surgery Patients With Underlying Atrial Fibrillation

This retrospective study used KROK registry data from Poland between 2012 and 2022 to examine six-year survival after treatment for atrial fibrillation (AF), comparing no treatment, surgical ablation (SA), left atrial appendage occlusion (LAAO), or SA plus LAAO. 33,949 patients were included in the final analysis. 81 percent of patients had no AF treatment, 11 percent had SA alone, 4 percent had LAAO alone, and 3 percent had combined SA and LAAO. Compared with no treatment, all other strategies had survival benefits. The gradient of survival benefit was SA and LAAO, then SA, and finally LAAO. Mortality benefits were similar when stratified for surgery type, except for aortic valve surgery, where LAAO alone was worse than no treatment. The findings support the use of both SA and LAAO in surgical management of AF.