AATS AFib Mini Theater with Dr. Armin Kiankhooy: “Surgical Ablation Improves Mortality: The Proof”

Video Categories: Publications, AATS
40 YouTube Views - Published June 30, 2020
Featured Speaker: Dr. Armin Kiankhooy




Video Overview

Watch Dr. Armin Kiankhooy as he presents several major publications highlighting the survival benefit of surgical ablation for the treatment of AF.


Video Transcript

For the hearing impaired members of the AFibSurgeons.org community, we have provided a written transcript below: 

Armin Kiankhooy: Does surgical ablation improve mortality? Yes, it does. Here’s that data. A lot of this data is just coming out. Dr. George put this slide together, which is fantastic. This is McCarthy’s study that was just released in 2020.

This is looking at midterm survival in patients treated for afib, propensity match comparison with patients who do not have afib. This is kind of what we were getting at earlier. Here is survival probability on the Y axis. This is follow up at five years.

In the red line down here you see untreated afib. In the blue line and green line here you see patients who had no afib in the green line, and then afib that was treated in the blue line. Again, what you see is that you restore that normal clinical pathway for these patients. Their survivability has gone back to essentially what it would have been if they had no afib to begin with. This is a great study by Dr. McCarthy and his group that just came out.

If you look at some of the other studies, again, this is another study by Dr. McCarthy and Dr. Malasarie in Northwestern were there looking at paroxysmal afib. Again, treated paroxysmal patients do better over a long term five years compared to patients who did not have their afib treated. Sometimes we don’t take paroxysmal afib seriously, but we definitely should be. You could really help those patients’ survival probability over time.

This is a study from Damiano’s group out of Wash U, again, comparing treated afib to untreated. It’s an excellent study that’s up to ten years now. This is long-term data looking at overall survival with treated afib. You can see folks who have had their afib treated with Cox-Maze IV do significantly better than those that don’t.

This other study was the Chamberlain paper that was presented just a couple years ago at the ATS meeting by Dr. Iribarne from the Northern New England Consortium. This was just an excellent study because it was a representation of what’s happening in the real world. What he highlighted in his consortium up in Northern New England was if you were to compare patients based on proportion surviving, patients who had no surgical ablation versus surgical ablation, how did those folks do, all of them out to five years, what he found is in this patient population in northern New England, CABGs, isolated valves, if you lump them all together and you sort out patients who have had some sort of surgical ablation versus no surgical ablation at all, folks who had a surgical ablation did significantly better than folks who did not.

What was really interesting about this study too is if you look at the data, I think only about 22% of patients in their entire patient cohort were actually treated. Even though only a small portion of patients were treated, it gave them significant improvement in the proportion surviving with any sort of surgical ablation. It didn’t even talk about a Cox-Maze IV versus the left versus the right. If you do some sort of ablation, these folk do better. This is kind of a real world example of what’s going on with afib treatment.

Unlike the other stuff we see, when you treat AS, patients get better right away. Just like somebody who is an expert in transcatheter treatment, I’m sure you see changes in the ventricle over time with AS. It’s kind of the same thing with afib. We’re looking at things that take time to happen. The ventricle changes over time.

Like we said, their medications change over time. What’s kind of cool is if you’re passionate about afib and following these patients out years and years down the road, it’s kind of fun when you treat them and they’re getting better the longer you’re following them. It’s not something we always see in cardiac surgery. Someone comes in at 72, you treat their afib, and they feel better at 75 than they did at 72. It’s a pretty cool process to be part of.