• Home
  • ACT Against Afib
  • Half of CABG Patients With Afib Are Still Being Left Behind – and The Data Proves It

Half of CABG Patients with Afib Are Still Being Left Behind – and the Data Proves It

Physicians in OR for CABG procedure

A major new study confirms: when it comes to treating Afib during bypass surgery, doing nothing has real consequences – and doing the right thing saves lives.

If you or someone you love is undergoing coronary artery bypass grafting (CABG) and also has atrial fibrillation (Afib), you might assume your surgical team would treat both problems at once. After all, you’re already on the table, already under anesthesia, already in the hands of a cardiac surgeon. It seems like a natural opportunity, and the best opportunity.

But you’d be surprised…

A landmark new study published in The Annals of Thoracic Surgery, drawing on data from nearly 60,000 Medicare patients across the country, found that 51% of Afib patients undergoing bypass surgery received absolutely no treatment for their Afib. Despite the fact that treating Afib during CABG has been a Society of Thoracic Surgeons (STS) Class I clinical guideline recommendation for nearly a decade.

Not only is this a missed opportunity, but according to this study’s data, it may be costing people their lives.

What the Study Found

Researchers analyzed patients from the STS national database between 2011 and 2022, tracking them long-term through Medicare records. They compared four groups of patients that received:

  • No Afib treatment during their bypass surgery
  • Left atrial appendage occlusion (LAAO) only
  • Epicardial ablation (EA) + LAAO: a procedure that uses energy delivered from outside the heart to disrupt the abnormal electrical signals driving Afib, combined with appendage closure
  • Intracardiac ablation (IA) + LAAO: a similar ablation technique performed from inside the heart

The results were profound…

The Case for Doing Both: Ablation + LAAO

  • Epicardial ablation with LAAO delivered the best long-term survival1. Patients who received this combination had significantly less intra and postoperative complications as well as superior long-term survival over the entire follow-up period compared to those who received no treatment.
  • Doing nothing was the worst outcome. Patients who received no Afib treatment had significantly higher all-cause mortality and higher rates of stroke compared to every treatment group.
  • LAAO only reduced stroke – but wasn’t enough on its own. Closing the left atrial appendage is valuable. All three treatment strategies reduced stroke risk significantly by 21% to 36% compared to no treatment. But, LAAO without ablation did not provide a survival advantage. The appendage closure addresses one consequence of Afib, but it doesn’t address the arrhythmia itself.

The message is clear: you need both. The ablation targets the root cause of the rhythm problem. The LAAO protects against stroke risk originating from the LAA. Together, they work. Neither alone is sufficient to move the needle on long-term survival.

Since We Know It Helps Patients Live Longer, Why Are So Many Still Going Untreated?

That’s the frustrating question this study raises. The good news: treatment rates are improving. In 2011, only about 32% of eligible patients received any Afib treatment during bypass surgery. By 2022, that number climbed to nearly 69%.

But look closer at what’s driving that improvement: much of it is LAAO alone – the appendage closure without the ablation. While that’s better than nothing for stroke reduction, the data tells us it’s not giving patients the survival benefit they deserve.

Does It Matter Whether Your Afib Is Paroxysmal or Persistent?

One of the more reassuring findings in this study: it doesn’t seem to. Whether a patient had paroxysmal Afib or persistent Afib, the benefits of treatment were consistent. The researchers found no meaningful difference in how the management strategies performed across Afib types.

That’s important because it removes a common reason for inaction. Surgeons and patients shouldn’t be using “well, it’s just paroxysmal” as a reason to skip Afib treatment during bypass surgery. The data doesn’t support that reasoning.

What This Means If You’re Facing Bypass Surgery

If you have Afib and you’re scheduled for, or considering coronary bypass surgery, this study gives you something important: data to advocate for yourself.

Ask your surgeon directly:

“What will you do to treat my Afib during this operation?”
“Can we discuss the benefits of epicardial ablation with left atrial appendage occlusion?”
“If ablation isn’t recommended for me, why not – and what are the risks of leaving my Afib untreated?”

Surgical ablation during bypass surgery is guideline-recommended and according to this large national dataset analyzed on this specific question, is associated with better survival and fewer strokes.

The Bottom Line

Half of Afib patients undergoing bypass surgery are still not getting the treatment that evidence supports. Based on the results from this data set – epicardial ablation combined with left atrial appendage occlusion – was found to be superior and is being underutilized, while many patients receive either nothing or an incomplete approach.

The data is in. Doing nothing has consequences. And doing only half the job isn’t enough.

References:

  1. Hawkins RB, Kubi B, Strobel RJ, Paneitz DC, Chang SC, Atshan R, Teman NR, Heid C, Beller J, Hirji SA, Spencer PJ, Chen Q, Bishawi M, Bowdish ME, Ganapathi AM, Sundt TM III, Habib RH, Mehaffey JH, Osho A, Long-Term Outcomes of Paroxysmal and Persistent Atrial Fibrillation Management Strategy During Non-Emergent Coronary Artery Bypass Surgery, The Annals of Thoracic Surgery (2026), doi: https://doi.org/10.1016/j.athoracsur.2026.04.055.
PM-US-5775A-0728-G