Surgical ablation during CABG increased survival in atrial fibrillation patients: Study

A recent study published in The Annals of Thoracic Surgery suggests that despite strong clinical guidelines, the use of surgical ablation during coronary artery bypass grafting (CABG) in patients with atrial fibrillation (AF) remains low and potentially life-shortening.

The study reviewed data from over 87,000 Medicare beneficiaries who had preexisting atrial fibrillation and underwent CABG between 2008 and 2019. This revealed that only 22.2% received concomitant surgical ablation. This technique targets the abnormal electrical signals causing AF and was associated with significantly improved long-term survival.

This study found that patients who received surgical ablation during CABG lived a median of 4.4 months longer than those who did not. Also, risk-adjusted median survival was 7.82 years in the ablation group when compared to 7.46 years in the non-ablation group (P < .001).

The survival benefit was even more pronounced when looked at the surgeon practice patterns. The patients operated on by surgeons who frequently perform ablation (defined as doing so in ≥40% of their CABG cases) had a median survival advantage of nearly 5 months (4.96 months) when compared to the patients treated by infrequent ablation surgeons (<5% of cases). Median survival in this analysis was 7.03 years versus 6.62 years, respectively (P < .001).

While the survival gains may appear modest on paper, the public health impact is substantial, given the high volume of CABG procedures and the prevalence of atrial fibrillation in older adults. This study argues that the findings support current guideline recommendations advocating for surgical ablation in AF patients undergoing CABG and spotlight a significant gap between evidence-based guidance and real-world practice.

In a detail examination, 652 surgeons (frequent ablation) performed the procedure in ≥40% of their CABG patients, 1834 surgeons (occasional ablation) performed it in 5–40% of cases and 1193 surgeons (infrequent ablation) did so in <5% of cases. These numbers suggest that a large proportion of cardiac surgeons either rarely or inconsistently offer this beneficial procedure.

As the study brought out, improving adherence to surgical ablation guidelines could meaningfully enhance long-term outcomes for tens of thousands of cardiac surgery patients every year. Overall, while surgical ablation during CABG clearly offers survival advantages, it remains underutilized, which calls for an urgent need for practice alignment with current evidence and guidelines.

Reference:

Schaffer, J. M., Kluis, A., Squiers, J. J., George, T. J., Shih, E., Banwait, J. K., Mack, M. J., & DiMaio, J. M. (2025). Survival after surgical ablation of atrial fibrillation during coronary artery bypass in Medicare beneficiaries. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2025.03.044