AFib Ablation During CABG Improves Survival. Summary:
AFib Ablation During CABG Improves Survival. Summary:
Source: The Annals of Thoracic Surgery – June 3, 2025
1. Study Focus:
Surgical ablation (Cox-Maze or modified Maze) of preexisting atrial fibrillation (AFib) during isolated CABG improves long-term survival among Medicare patients.
2. Cohort Details:
• Data from ~88,000 Medicare beneficiaries with preexisting AFib undergoing CABG.
• Only 22.2% underwent concomitant surgical ablation.
• Just 652 surgeons performed ablation “frequently”, vs. 3,027 who did so “occasionally or rarely”.
3. Key Outcomes:
• Median survival benefit of 4.4 months in patients receiving ablation during CABG (risk-adjusted).
• No increased risk of stroke or transient ischemic attack (TIA) observed.
4. Interpretation:
• The survival benefit became evident more than 2 years post-CABG.
• Authors hypothesize this results from reduced incidence of tachycardia-induced heart failure.
5. Clinical Relevance:
• Guidelines recommend surgical ablation with CABG when indicated, but it’s underutilized.
• Results support greater adherence to guidelines and reevaluation of surgical decision-making in AFib patients.
6. Procedure Type & Team Involvement:
The ablation performed in this study refers to surgical ablation(modified Maze), commonly done during open-heart procedures using techniques such as the Cox-Maze IV or modified Maze procedures. These are typically carried out by cardiac surgeons, especially when concomitant with CABG.
However, the role of electrophysiologists (EPs) remains central in patient selection, mapping strategies, perioperative rhythm evaluation, and long-term arrhythmia management.
In advanced centers, hybrid ablation models—combining surgical and catheter-based approaches—are increasingly used for complex or refractory AFib cases.
7. Terminology Note: Origins of the “Maze” Procedure
The term “Cox-Maze” originates from Dr. James Cox, who first developed the procedure in 1987 using a complex “cut-and-sew” surgical pattern designed to disrupt reentrant circuits in atrial fibrillation (AF). This original technique, later known as Cox-Maze I, was highly effective but technically demanding. To simplify the approach, the Cox-Maze IV was introduced, replacing incisions with energy-based ablation lines (radiofrequency or cryothermy). While less invasive, it preserves the core lesion design and clinical objectives of the original Maze. Hence, the term “modified Maze” is commonly used today to describe these modern adaptations of the original concept.
Implication: Reinforces that combining AFib ablation with CABG in eligible patients may lead to meaningful survival gains without added stroke risk.
https://www.annalsthoracicsurgery.org/article/S0003-4975(25)00339-X/abstract
