Concomitant Treatment of Atrial Fibrillation in Isolated Coronary Artery Bypass Grafting

BACKGROUND Societal guidelines support concomitant management of atrial fibrillation (AF) in patients undergoing cardiac surgery. To assess real world adoption and outcomes, we evaluated Medicare Beneficiaries with AF undergoing isolated Coronary Artery Bypass Grafting (CABG) with surgical ablation (SA) and/or left atrial appendage obliteration (LAAO). METHODS United States Centers for Medicare and Medicaid Services inpatient claims database identified all patients with AF undergoing isolated CABG (2018-20). Diagnosis-related group and International Classification of Diseases 10th revision procedure codes defined covariates for doubly robust risk adjustment. RESULTS A total of 19,524 patients with preoperative AF undergoing isolated CABG were stratified by SA+LAAO (3,475; 17.8%), LAAO only (4,541; 23.3%), or no AF Treatment (11,508; 58.9%). After doubly robust risk-adjustment, longitudinal analysis highlighted concomitant AF treatment with SA+LAAO (HR 0.74, p=0.049) or LAAO Alone (HR 0.75, p=0. 031) was associated with significant reduction in readmission for stroke at 3 years compared to No AF Treatment. Furthermore, SA+LAAO (HR 0.86, p=0.016) but not LAAO Alone (HR 0.97, p=0.573) was associated with improved survival compared to No AF Treatment. Finally, SA+LAAO was associated with superior composite outcome of freedom from stroke or death at 3 years compared to LAAO Alone (HR 0.86, p=0.033) or No AF Treatment (HR 0.81, p=0.001). CONCLUSIONS In Medicare beneficiaries with AF undergoing isolated CABG, concomitant AF treatment was associated with reduced three-year readmission for stroke. SA+LAAO was associated with superior reduction in stroke or death at three years compared to LAAO Alone or No AF Treatment.