Comparative results of pulmonary vein isolation in atrial fibrillation patients undergoing off-pump vs. on-pump beating-heart coronary artery bypass grafting - a retrospective cohort study

Q: What was the primary purpose of the study?

To compare outcomes of pulmonary vein isolation as a concomitant procedure during off-pump versus on-pump beating-heart CABG in atrial fibrillation patients.

Q: How were the main endpoints defined?

Primary endpoints were sinus rhythm (with or without antiarrhythmic drugs) and overall survival; secondary endpoints included MACCE and anticoagulation status at follow-up.

Q: What were the key safety outcomes during follow-up?

Follow-up was 100% at a median of 24 months, and no strokes or myocardial infarctions occurred, resulting in MACCE-free survival equaling overall survival.

Sep 30, 2026

Upload by Ophelia

Retrospective single-centre evidence evaluates pulmonary vein isolation (PVI) and left atrial appendage occlusion (LAAO) as concomitant procedures during coronary artery bypass grafting (CABG) in patients with atrial fibrillation, comparing off-pump to on-pump beating-heart techniques. Consecutive patients undergoing epicardial PVI between December 2021 and November 2024 were followed for a median of 24 months with primary endpoints of sinus rhythm maintenance and overall survival. Follow-up showed 100% completeness, no strokes or myocardial infarctions, and no statistically significant between-group differences in rhythm or survival outcomes.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Introduction

Methods

Results

Conclusions

Highlight box

Key findings

What is known and what is new?

Comparative results of pulmonary vein isolation in atrial fibrillation patients undergoing off-pump vs. on-pump beating-heart coronary artery bypass grafting: a retrospective cohort study Magdalena Rufa1^, Adrian Ursulescu1, Ragi Nagib1, Samir Ahad1, Tunjay Shavahatli1, Rafael Ayala1, Ulrich F.W. Franke2, Bartosz Rylski1 1Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany; 2Department of Cardiovascular Surgery, University Heart Centre Freiburg Bad Krozingen, Freiburg, Germany Contributions: (I) Conception and design: M Rufa; (II) Administrative support: A Ursulescu, UF Franke, B Rylski; (III) Provision of study materials or patients: A Ursulescu, S Ahad, R Nagib; (IV) Collection and assembly of data: M Rufa, T Shavahatli, R Ayala; (V) Data analysis and interpretation: MRufa; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Magdalena Rufa, MD. Department of Cardiovascular Surgery, Robert Bosch Hospital, Auerbachstrasse 110, Stuttgart 70376, [Germany. Email: Magdalena.Rufa@rbk.de](Germany. Email: Magdalena.Rufa@rbk.de). Background: Coronary artery disease is the second leading cause of death across all age groups, while the prevalence of atrial fibrillation (AF) is increasing in the general population. This situation highlights the significant issue of concomitant surgical treatment for these two conditions. We aimed to investigate the safety and efficiency of pulmonary vein isolation (PVI) and left atrial appendage occlusion (LAAO) as concomitant procedures in patients undergoing off-vs. on-pump beating-heart coronary artery bypass grafting (CABG) at our centre. Methods: This retrospective single-centre cohort included consecutive patients with AF who underwent CABG with concomitant epicardial PVI between December 2021 and November 2024 at Robert Bosch Hospital. Patients without preoperative AF, emergency cases, and those undergoing non-CABG concomitant procedures were excluded. Of 44 included patients, 27 had off-pump CABG (OPCAB) and 17 had onpump beating-heart CABG. Primary endpoints were sinus rhythm (SR) maintenance with or without antiarrhythmic drugs (AADs) and overall survival (OS); secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and anticoagulation status at follow-up. Group comparisons used χ2 and Mann-Whitney U tests (two-sided, P<0.05) . Results: Follow-up was 100% at a median of 24 months. SR without AADs was observed in 77.7% of OPCAB and 64.7% of on-pump beating-heart patients; with AADs, rates were 81.4% and 70.5%, respectively. OS was in the OPCAB group 92%, respectively 94% in the on-pump beating-heart group. No strokes or myocardial infarctions occurred during follow-up; therefore MACCE-free, survival equalled OS. Oral anticoagulation was discontinued in 18.2% of patients, all in SR. No statistically significant between group differences were detected for rhythm or survival outcomes. Conclusions: In patients with AF undergoing CABG, concomitant PVI yielded high SR maintenance and excellent mid-term survival in both off-pump and on-pump beating-heart settings, with no stroke or myocardial infarction observed at follow-up. These findings support the feasibility and safety of integrating PVI into CABG—including OPCAB—for appropriately selected patients. Keywords: Atrial fibrillation (AF); concomitant surgical ablation; pulmonary vein isolation (PVI); left atrial appendage occlusion (LAAO); coronary artery bypass grafting (CABG) ^ ORCID: 0000-0003-0395-9834. © AME Publishing Company. Cardiovasc Diagn Ther 2025;15(6):1134-1148 | [https://dx.doi.org/10.21037/cdt-2025-464](https://dx.doi.org/10.21037/cdt-2025-464) Cardiovascular Diagnosis and Therapy, Vol 15, No 6 December 2025 1135 Submitted Aug 15, 2025. Accepted for publication Nov 26, 2025. Published online Dec 24, 2025. doi: 10.21037/cdt-2025-464 View this article at: [https://dx.doi.org/10.21037/cdt-2

FAQs

What was the primary purpose of the study?

To compare outcomes of pulmonary vein isolation as a concomitant procedure during off-pump versus on-pump beating-heart CABG in atrial fibrillation patients.

How were the main endpoints defined?

Primary endpoints were sinus rhythm (with or without antiarrhythmic drugs) and overall survival; secondary endpoints included MACCE and anticoagulation status at follow-up.

What were the key safety outcomes during follow-up?

Follow-up was 100% at a median of 24 months, and no strokes or myocardial infarctions occurred, resulting in MACCE-free survival equaling overall survival.

Sep 30, 2026

Upload by Ophelia