Epicardial Ablation in Atrial Fibrillation: How Do Outcomes Differ Between Patients with Paroxysmal and Non-paroxysmal Atrial Fibrillation? Insights from the CASE-AF Registry

Background: The German CardioSurgery Atrial Fibrillation Registry (CASE-AF Registry) is the largest national, prospective, multicentric registry analyzing the outcomes of patients undergoing surgical ablation (SA) for atrial fibrillation (AF) in a cardiac surgical setting for concomitant or stand-alone procedures. This sub-analysis of the CASE-AF registry aims to analyze and compare the 1-year outcomes of epicardial SA in patients with paroxysmal AF (PAF) and non-paroxysmal AF (non-PAF) in a concomitant cardiac surgery setting.

Methods: Between January 2017 and April 2020, 17 German cardio-surgical units enrolled 763 consecutive patients who underwent concomitant SA. For our analysis, we included only the patients who underwent concomitant epicardial SA, categorized into two groups based on their AF type: PAF and non-PAF. Pre-, intra-, and postoperative data were collected. One-year procedural success was defined as the absence of AF after blanking period without the need for re-ablation and electrical cardioversion. The protocol mandated telephone-based follow-up contact after 1 year.

Results: A total of 413 patients were included in the study, with 254 patients (61.5%) in the PAF group and 159 patients (38.5%) in the non-PAF group. The demographics of both groups were similar. One-year follow-up examinations were completed in 97.2% (n = 247) and 96.9% (n = 154) cases (p = 0.82) and 1-year procedural success was reported in 61.9% (n = 146) and 52.7% (n = 77) of PAF and non-PAF patients, respectively (p = 0.079). Significant improvement in baseline modified European Heart Rhythm Association (mEHRA) was reported in both group of patients. There were no statistical differences in 1-year mortality and complication rates between the two groups. The stroke was reported in 2.7% (n = 6) of the patients in PAF and in 2.9% (n = 4) of the patients in non-PAF group (p = 0.92). Neither pulmonary vein stenosis nor arterioesophageal fistula cases were observed in any patients in both groups.

Conclusion: Epicardial SA is safe and effective, with significant improvement in patient symptoms and freedom from AF. No differences in safety outcomes or freedom from AF were observed between the PAF group and non-PAF group of patients during the follow-up period.

Publication History

Article published online:
11 February 2025