1
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Emiola A, Kluin J, El Mathari S, de Groot JR, van Boven WJ. Interventions to prevent postoperative atrial fibrillation in Dutch cardiothoracic centres: a survey study. Neth Heart J 2024; 32:173-181. [PMID: 38358408 PMCID: PMC10951169 DOI: 10.1007/s12471-023-01849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) is a common phenomenon following cardiac surgery. In this study, we assessed current preventive strategies used by Dutch cardiothoracic centres, identified common views on this matter and related these to international guidelines. METHODS We developed an online questionnaire and sent it to all cardiothoracic surgery centres in the Netherlands. The questionnaire concerned the management of POAF and the use of pharmaceutical therapies (beta-blockers and calcium antagonists) and non-pharmaceutical methods (posterior left pericardiotomy, pericardial flushing and epicardial botulinum toxin type A injections). Usage of electrical cardioversions, anticoagulants and left atrial appendage closure were also enquired. RESULTS Of the 15 centres, 14 (93%) responded to the survey and 13 reported a POAF incidence, ranging from 20 to 30%. Of these 14 centres, 6 prescribed preoperative AF prophylaxis to their patients, of which non-sotalol beta-blockers were prescribed most commonly (57%). Postoperative medication was administered by all centres and included non-sotalol beta-blockers (38%), sotalol (24%), digoxin (14%), calcium antagonists (13%) and amiodarone (10%). Only 2 centres used posterior left pericardiotomy or pericardial flushing as surgical manoeuvres to prevent POAF. Moreover, respondents expressed the need for guidance on anticoagulant use. CONCLUSION Despite the use of various preventive strategies, the reported incidence of POAF was similar in Dutch cardiothoracic centres. This study highlights limited use of prophylactic amiodarone and colchicine, despite recommendations by numerous guidelines, and restricted implementation of surgical strategies to prevent POAF.
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Affiliation(s)
- Angelique Emiola
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Wim-Jan van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
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2
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Kumar NS, Khanji MY, Patel KP, Ricci F, Providencia R, Chahal A, Sohaib A, Awad WI. Surgical management of atrial fibrillation in patients undergoing cardiac surgery: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:14-24. [PMID: 37873664 DOI: 10.1093/ehjqcco/qcad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
AIMS Surgical ablation of atrial fibrillation (AF) has been demonstrated to be a safe procedure conducted concomitantly alongside cardiac surgery. However, there are conflicting guideline recommendations surrounding indications for surgical ablation. We conducted a systematic review of current recommendations on concomitant surgical AF ablation. METHODS AND RESULTS We identified publications from MEDLINE and EMBASE between January 2011 and December 2022 and additionally searched Guideline libraries and websites of relevant organizations in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 895 studies screened, 4 were rigorously developed (AGREE-II > 50%) and included. All guidelines agreed on the definitions of paroxysmal, persistent, and longstanding AF based on duration and refraction to current treatment modalities. In the Australia-New Zealand (CSANZ) and European (EACTS) guidelines, opportunistic screening for patients >65 years is recommended. The EACTS recommends systematic screening for those aged >75 or at high stroke risk (Class IIa, Level B). However, this was not recommended by American Heart Association or Society of Thoracic Surgeons guidelines. All guidelines identified surgical AF ablation during concomitant cardiac surgery as safe and recommended for consideration by a Heart Team with notable variation in recommendation strength and the specific indication (three guidelines fail to specify any indication for surgery). Only the STS recommended left atrial appendage occlusion (LAAO) alongside surgical ablation (Class IIa, Level C). CONCLUSION Disagreements exist in recommendations for specific indications for concomitant AF ablation and LAAO, with the decision subject to Heart Team assessment. Further evidence is needed to develop recommendations for specific indications for concomitant AF procedures and guidelines need to be made congruent.
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Affiliation(s)
- Niraj S Kumar
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- National Medical Research Association, London, UK
| | - Mohammed Y Khanji
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Newham University Hospital, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Kush P Patel
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rui Providencia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anwar Chahal
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Wael I Awad
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- University of South Wales, Cardiff, UK
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3
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Anduaga I, Affronti A, Cepas-Guillén P, Alcocer J, Flores-Umanzor E, Regueiro A, Brugaletta S, Quintana E, Sanchis L, Sabaté M, Freixa X. Non-Pharmacological Stroke Prevention in Atrial Fibrillation. J Clin Med 2023; 12:5524. [PMID: 37685589 PMCID: PMC10488500 DOI: 10.3390/jcm12175524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide. It is associated with increased mortality and morbidity, especially due to the increased risk of ischemic stroke and systemic embolism in these patients. For this reason, thromboembolism prevention is the cornerstone of managing AF, and oral anticoagulation is nowadays the first-line treatment. However, since most thrombi form in the left atrial appendage and anticoagulant therapy may have side effects and be contraindicated in some patients, surgical and percutaneous left atrial appendage occlusion (LAAO) have emerged as a non-pharmacological alternative. This review summarizes all existing evidence on surgical and percutaneous LAAO.
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Affiliation(s)
- Iñigo Anduaga
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Alessandro Affronti
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Pedro Cepas-Guillén
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Jorge Alcocer
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eduardo Flores-Umanzor
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Eduard Quintana
- Cardiovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Laura Sanchis
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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4
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Left Atrial Appendage Exclusion in Atrial Fibrillation Radiofrequency Ablation during Mitral Valve Surgery: A Single-Center Experience. Cardiol Res Pract 2021; 2021:9999412. [PMID: 34394984 PMCID: PMC8355965 DOI: 10.1155/2021/9999412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation surgical radiofrequency ablation (AFSA) during mitral valve surgery (MVS) has almost completely superseded the Cox-Maze procedure for the treatment of atrial fibrillation. Methods We retrospectively analyzed 100 patients who underwent MVS + AFSA in our institution from January 2008 to June 2017. We compared the effectiveness of AFSA in patients who underwent LAA exclusion to those who did not. Moreover, we analyzed the role of preoperative AF duration (≤ or >1 year) and medial-lateral left atrial dimensions (ML-LAD) (≤ or >6 cm). The efficacy endpoint was freedom from AF at discharge and at 2-year follow-up. The safety endpoints were need of a permanent pacemaker (PMK), surgical re-exploration, occurrence of stroke, and left circumflex artery or esophageal lesions. Results Overall, the rate of AF freedom was 69% at discharge and 80% at 2-year follow-up. LAA exclusion did not influence AF freedom at 2-year follow-up, and 84.6% of patients who underwent LAA exclusion were in the sinus rythm (SR) at 2 year compared to 75% of those who did not receive LAA exclusion free from AF as well (p=0.230). AF duration ≤1 or >1 year did not influence sinus rhythm (SR) maintenance (85.7% vs. 75.8%; p=0.224), and in these two groups, LAA exclusion did not change the efficacy of AFSA. ML-LAD ≤ 6 cm was associated with better results in terms of SR maintenance. A statistically significant association between LAA exclusion and SR maintenance at 2-year follow-up (p=0.017) was found among patients with ML-LAD ≤ 6 cm. Complications included 7 cases of PMK implantation, 2 cases of surgical re-exploration, and 1 case of stroke. No circumflex artery or esophageal lesions occurred after surgical procedures. Conclusions In our experience, AFSA during isolated MVS resulted in good outcomes in terms of SR maintenance and incidence of complications. AF duration ≤ 1 year did not influence results, while patients with ML-LAD ≤ 6 cm had significantly better results regarding SR at follow-up. In patients with ML-LAD ≤ 6 cm, LAA exclusion significantly increased the success rate of SR maintenance at 2-year follow-up.
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5
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Magni FT, Al-Jazairi MIH, Mulder BA, Klinkenberg T, Van Gelder IC, Rienstra M, Mariani MA, Blaauw Y. First-line treatment of persistent and long-standing persistent atrial fibrillation with single-stage hybrid ablation: a 2-year follow-up study. Europace 2021; 23:1568-1576. [PMID: 34143871 PMCID: PMC8502496 DOI: 10.1093/europace/euab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/26/2021] [Indexed: 11/24/2022] Open
Abstract
Aims This study evaluates the efficacy and safety of first-line single-stage hybrid ablation of (long-standing) persistent atrial fibrillation (AF), over a follow-up period of 2 years, and provides additional information on arrhythmia recurrences and electrophysiological findings at repeat ablation. Methods and results This is a prospective cohort study that included 49 patients (65% persistent AF; 35% long-standing persistent AF) who underwent hybrid ablation as first-line ablation treatment (no previous endocardial ablation). Patients were relatively young (57.0 ± 8.5 years) and predominantly male (89.8%). Median CHA2DS2-VASc score was 1.0 (0.5; 2.0) and mean left atrium volume index was 43.7 ± 10.9 mL/m2. Efficacy was assessed by 12-lead electrocardiography and 72-h Holter monitoring after 3, 6, 12, and 24 months. Recurrence was defined as AF/atrial flutter (AFL)/tachycardia (AT) recorded by electrocardiography or Holter monitoring lasting >30 s during 2-year follow-up. At 2-year follow-up, single and multiple procedure success rates were 67% and 82%, respectively. Two (4%) patients experienced a major complication (bleeding) requiring intervention following hybrid ablation. Among the 16 (33%) patients who experienced an AF/AFL/AT recurrence, 13 (81%) were ATs/AFLs and only 3 (19%) were AF. Repeat ablation was performed in 10 (20%) patients and resulted in sinus rhythm in 7 (70%) at 2-year follow-up. Conclusion First-line single-stage hybrid AF ablation is an effective treatment strategy for patients with persistent and long-standing persistent AF with an acceptable rate of major complications. Recurrences are predominantly AFL/AT that can be successfully ablated percutaneously. Hybrid ablation seems a feasible approach for first-line ablation of (long-standing) persistent AF.
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Affiliation(s)
- Federico T Magni
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.,Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Meelad I H Al-Jazairi
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Theo Klinkenberg
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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6
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Steinberg JS, Romanov A. Left Atrial Appendage Isolation for Ablation of Atrial Fibrillation: Has a Yellow Flag Been Raised? JACC Clin Electrophysiol 2021; 6:1698-1700. [PMID: 33334449 DOI: 10.1016/j.jacep.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Jonathan S Steinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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7
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Boersma LVA. Surgical or catheter ablation for longstanding persistent atrial fibrillation: a game of rock paper scissors? Eur Heart J 2020; 41:4481-4482. [PMID: 33068397 DOI: 10.1093/eurheartj/ehaa751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein, PO 2500, 3430 EM, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam Uinversity Medical Centers, Amsterdam, The Netherlands
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8
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Pearman CM, Redfern J, Williams EA, Snowdon RL, Modi P, Hall MCS, Modi S, Waktare JEP, Mahida S, Todd DM, Mediratta N, Gupta D. Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation. Europace 2020; 21:738-745. [PMID: 30753411 PMCID: PMC6479510 DOI: 10.1093/europace/euy303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.
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Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, 3.14 Core Technology Facility, University of Manchester, Manchester, UK
| | - James Redfern
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Emmanuel A Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Paul Modi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Simon Modi
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Johan E P Waktare
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Derick M Todd
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, UK
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9
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Subxiphoid Hybrid Epicardial-Endocardial Atrial Fibrillation Ablation and LAA Ligation: Initial Sub-X Hybrid MAZE Registry Results. JACC Clin Electrophysiol 2020; 6:1603-1615. [PMID: 33334437 DOI: 10.1016/j.jacep.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and efficacy of a new subxiphoid hybrid epicardial-endocardial atrial fibrillation (AF) ablation and left atrial appendage (LAA) ligation approach for the treatment of persistent AF. BACKGROUND Surgical hybrid ablation procedures have shown promise for maintaining sinus rhythm versus catheter ablation but are associated with increased periprocedural adverse events. METHODS Patients with symptomatic persistent AF (n = 33, mean age 64 ± 9 years, 25 men) who had antiarrhythmic drug therapy or prior catheter ablation was unsuccessful were referred for hybrid epicardial-endocardial AF ablation and LAA exclusion. LAA closure was confirmed by transesophageal echocardiographic Doppler flow and/or computed tomographic angiography 1 to 3 months post-ligation. The incidence of atrial tachycardia or AF recurrence, LAA closure, thromboembolic events, and post-operative complications were assessed. RESULTS All 33 patients underwent successful LAA ligation with epicardial ablation of the posterior left atrial wall, as well as endocardial pulmonary vein isolation and cavotricuspid isthmus ablation. Freedom from atrial tachycardia or AF was 91% (20 of 22 patients) at 6 months, 90% (18 of 20 patients) at 12 months, 92% (11 of 12 patients) at 18 months, and 92% (11 of 12) at 24 months. There were no acute periprocedural complications (<7 days). Thirty-day adverse events included 2 patients with pericardial effusion requiring pericardiocentesis and 1 incisional hernia repair. There were no long-term complications, strokes, or deaths. LAA ligation was complete in 27 of 33 subjects (82%), with 6 subjects having leaks of <5 mm. CONCLUSIONS Subxiphoid hybrid epicardial-endocardial ablation with LAA ligation is feasible, safe, and effective. Future prospective studies are needed to validate these initial findings.
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10
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Harky A, Bithas C, Chan JSK, Snosi M, Pousios D, Muir AD. Surgical Treatment of Atrial Fibrillation: Cutting Through the Edges. Braz J Cardiovasc Surg 2020; 35:375-386. [PMID: 32549109 PMCID: PMC7299594 DOI: 10.21470/1678-9741-2019-0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Medical management of atrial fibrillation can be complex, challenging and requiring time to prove its effectiveness; furthermore, the response can be refractory and inconsistent if the underlying pathology is not permanently addressed. Surgical ablation has become a key intervention, and since its first intervention in 1987 (the Cox-maze procedure), the technique has evolved from a conventional open method to a minimally invasive technique whilst retaining excellent outcomes. Furthermore, recent advances in the use of a hybrid approach have been established as satisfactory approach in managing atrial fibrillation with satisfactory outcomes. This literature review focuses on the evidence behind the surgical success in managing atrial fibrillation throughout the past, present and the future of these surgical interventions.
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Affiliation(s)
- Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Christiana Bithas
- University of Liverpool School of Medicine Liverpool UK School of Medicine, University of Liverpool, Liverpool, UK
| | - Jeffrey Shi Kai Chan
- University of Hong Kong Faculty of Medicine Shatin New Territories Hong Kong Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,Prince of Wales Hospital Department of Medicine and Therapeutics Division of Cardiology Shatin New Territories Hong Kong Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Mostafa Snosi
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dimitrios Pousios
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Andrew D Muir
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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11
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Edgerton JR. Current State of Surgical Left Atrial Appendage Exclusion: How and When. Card Electrophysiol Clin 2020; 12:109-115. [PMID: 32067640 DOI: 10.1016/j.ccep.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left atrial appendage exclusion is efficacious for stroke prophylaxis in patients with atrial fibrillation. Surgical excision provides reliable left atrial appendage exclusion, whereas surgical occlusion does not. Specifically, 2-layer internal suture ligation has a high failure rate. Left atrial appendage exclusion concomitant to another cardiac surgical procedure is indicated in patients with atrial fibrillation but not in patients without baseline atrial fibrillation. Studies currently underway will further define the role of concomitant surgical left atrial appendage exclusion, especially for the population without baseline atrial fibrillation but at high risk of developing postoperative atrial fibrillation.
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Affiliation(s)
- James R Edgerton
- Department of Epidemiology, Baylor Scott and White Health, PO Box 190667, Dallas, TX 75219, USA.
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12
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Mohanty S, Di Biase L, Trivedi C, Choudhury F, Della Rocca DG, Romero J, Gianni C, Sanchez J, Hranitzky P, Gallinghouse GJ, Al‐Ahmad A, Horton RP, Burkhardt D, Natale A. Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:339-347. [DOI: 10.1111/jce.13825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sanghamitra Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
- Department of Internal Medicine, Dell Medical SchoolAustin Texas
| | - Luigi Di Biase
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
- Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore HospitalNew York New York
| | - Chintan Trivedi
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | | | - Domenico G. Della Rocca
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Jorge Romero
- Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore HospitalNew York New York
| | - Carola Gianni
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Javier Sanchez
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Patrick Hranitzky
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - G. Joseph Gallinghouse
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Amin Al‐Ahmad
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Rodney P. Horton
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - David Burkhardt
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St David's Medical CenterAustin Texas
- Department of Internal Medicine, Dell Medical SchoolAustin Texas
- Interventional ElectrophysiologyScripps ClinicLa Jolla California
- Department of Electrophysiology, Metro Health Medical Center, Case Western Reserve University School of MedicineCleveland Ohio
- Department of Cardiology, Division of Cardiology, Stanford UniversityStanford California
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13
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Sindby JE, Vadmann H, Lundbye-Christensen S, Riahi S, Hjortshøj S, Boersma LVA, Andreasen JJ. Percutaneous versus thoracoscopic ablation of symptomatic paroxysmal atrial fibrillation: a randomised controlled trial - the FAST II study. J Cardiothorac Surg 2018; 13:101. [PMID: 30285795 PMCID: PMC6171190 DOI: 10.1186/s13019-018-0792-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The most efficient first-time invasive treatment, for achieving sinus rhythm, in symptomatic paroxysmal atrial fibrillation has not been established. We aimed to compare percutaneous catheter and video-assisted thoracoscopic pulmonary vein radiofrequency ablation in patients referred for first-time invasive treatment due to symptomatic paroxysmal atrial fibrillation. The primary outcome of interest was the prevalence of atrial fibrillation with and without anti-arrhythmic drugs at 12 months. METHODS Ninety patients were planned to be randomised to either video-assisted thoracoscopic radiofrequency pulmonary vein ablation with concomitant left atrial appendage excision or percutaneous catheter pulmonary vein ablation. Episodes of atrial fibrillation were defined as more than 30 s of atrial fibrillation observed on Holter monitoring/telemetry or clinical episodes documented by ECG. RESULTS The study was terminated prematurely due to a lack of eligible patients. Only 21 patients were randomised and treated according to the study protocol. Thoracoscopic pulmonary vein ablation was performed in 10 patients, and 11 patients were treated with catheter ablation. The absence of atrial fibrillation without the use of anti-arrhythmic drugs throughout the follow-up was observed in 70% of patients following thoracoscopic pulmonary vein ablation and 18% after catheter ablation (p < 0.03). CONCLUSION Thoracoscopic pulmonary vein ablation may be superior to catheter ablation for first-time invasive treatment of symptomatic paroxysmal atrial fibrillation with regard to obtaining sinus rhythm off anti-arrhythmic drugs 12 months postoperative. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01336075 . Registered April 15th, 2011.
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Affiliation(s)
- Jesper Eske Sindby
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henrik Vadmann
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- AMC Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
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14
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Tilz RR, Eitel C. Left Atrial Appendage Electric Isolation for Treatment of Atrial Fibrillation: Experimental Approach or Standard of Care? JACC Clin Electrophysiol 2018; 4:121-123. [PMID: 29600776 DOI: 10.1016/j.jacep.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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15
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Lin AC, Knight BP. What Is the Role of Left Atrial Appendage Closure in the Rhythm Control of Atrial Fibrillation? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:24. [DOI: 10.1007/s11936-018-0620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Left Atrial Appendage Electrical Isolation for Treatment of Recurrent Atrial Fibrillation: A Meta-Analysis. JACC Clin Electrophysiol 2018; 4:112-120. [PMID: 29600775 PMCID: PMC9902022 DOI: 10.1016/j.jacep.2017.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In this study, the authors sought to perform a meta-analysis of controlled studies assessing the relationship between left atrial appendage (LAA) electrical isolation (EI) and recurrent atrial fibrillation (AF). BACKGROUND LAA triggers could play an important role in AF and can be treated with complete EI of the LAA via surgical or percutaneous approaches. METHODS We conducted a meta-analysis of all controlled studies published as of November 21, 2016, assessing the relationship between left atrial appendage electrical isolation (LAAEI) and recurrent AF. The primary endpoint was atrial tachycardia (AT) or AF recurrence after the post-procedure blanking period. The association between LAAEI and AT/AF was estimated using random-effects modeling. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian and Laird method. RESULTS We identified 7 studies including 1,037 patients; LAAEI was performed in 566 patients (55%). LAAEI was associated with a significantly lower rate of AT/AF recurrence in the primary analysis (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.02). The association between LAAEI and recurrent AT/AF was strongest in a sensitivity analysis restricted to studies of percutaneous LAAEI (OR: 0.22; 95% CI: 0.11 to 0.46; p < 0.001; 5 studies, n = 623). LAAEI was not associated with thromboembolism (OR: 0.50; 95% CI: 0.18 to 1.39; p = 0.18; 5 studies, n = 767), although these studies either incorporated LAA occlusion (3 studies, n = 552 patients) or follow-up echocardiography to assess LAA function (2 studies, n = 215 patients) to inform antithrombotic strategies. CONCLUSIONS LAAEI is associated with a significant reduction in recurrent AT/AF. Randomized trials are required to confirm the efficacy and long-term safety of LAAEI and to determine the optimal concomitant antithrombotic strategy.
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17
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 694] [Impact Index Per Article: 115.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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18
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1347] [Impact Index Per Article: 192.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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19
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Risk of Intraatrial Thrombi After Thoracoscopic Ablation in Absence of Heparin and Appendage Closure. Ann Thorac Surg 2017; 104:790-796. [DOI: 10.1016/j.athoracsur.2017.01.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/27/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
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20
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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22
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Osmancik P, Budera P. The future of hybrid ablation: an emerging need for an anticoagulation protocol for thoracoscopic ablation. J Thorac Dis 2017; 9:E322-E326. [PMID: 28449532 DOI: 10.21037/jtd.2017.02.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The midterm efficacy of hybrid ablation of atrial fibrillation (AF) reported in recent papers is about 70% in terms of sinus rhythm maintenance without antiarrhythmic drugs. Bearing in mind that the majority of patients enrolled are patients with persistent and long-standing persistent AF, the reported efficacies seem to be very good. Despite the high efficacies, safety remains a critical issue in hybrid, and especially thoracoscopic ablations. The frequency of complications during thoracoscopic ablations is more than 10% in the majority of reports. Most are short-term with no sequelae (such as pneumothorax or pneumonia); however, life-threatening complications have also been described, e.g., a sternotomy in response to a laceration of the left atrium (LA). One of the most serious ablation complications is stroke. The rate of strokes, which has been reported during or shortly after thoracoscopic ablation, seems to be higher than the rate reported after catheter ablation. This is especially true in papers describing thoracoscopic ablations that were not immediately followed by a catheter ablation. A possible explanation is differences in anticoagulation management during the two procedures. During catheter endocardial procedures, a standard anticoagulation protocol exists and is routinely applied; however, there is no such set of recommendations for anticoagulation during the thoracoscopic-phase of an ablation. It seems probable that, in many cases, no anticoagulation is used during thoracoscopic ablations. Moreover, whatever anticoagulation protocol is used during thoracoscopic ablations often goes unreported. A discussion about the best anticoagulation strategy during thoracoscopic ablation is urgently needed. In the future, standards of anticoagulation during thoracoscopic ablation should be clearly reported, just as they are now for catheter ablations.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Budera
- Clinic of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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23
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Pearman CM, Poon SS, Bonnett LJ, Haldar S, Wong T, Mediratta N, Gupta D. Minimally Invasive Epicardial Surgical Ablation Alone Versus Hybrid Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis. Arrhythm Electrophysiol Rev 2017; 6:202-209. [PMID: 29326836 DOI: 10.15420/aer/2017.29.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Maintaining sinus rhythm in patients with non-paroxysmal AF is an elusive goal. Some suggest that hybrid ablation, combining minimally invasive epicardial surgical ablation with endocardial catheter ablation, may be more effective than either modality alone. However, randomised trials are lacking. We investigated whether hybrid ablation is more effective than epicardial ablation alone at preventing recurrent AF by performing a systematic review and meta-analysis. The review was prospectively registered with PROSPERO (CRD42016043389). MEDLINE and EMBASE were searched for studies of standalone minimally invasive epicardial ablation of AF and/or hybrid ablation, identifying 41 non-overlapping studies comprising 2737 patients. A random-effects meta-analysis, meta-regression and sensitivity analysis were performed. Single-procedure survival free from atrial arrhythmias without antiarrhythmic drugs was similar between epicardial-alone and hybrid approaches at 12 months (epicardial alone 71.5 %; [95 % CI 66.1-76.9], hybrid 63.2 %; [95 % CI 51.5-75.0]) and 24 months (epicardial alone 68.5 %; [95 % CI 57.7-79.3], hybrid 57.0 %; [95 % CI 33.6-80.4]). Freedom from atrial arrhythmias with AADs and rates of unplanned additional catheter ablations were also similar between groups. Major complications occurred more often with hybrid ablation (epicardial alone 2.9 %; [95 % CI 1.9-3.9], hybrid 7.3 %; [95 % CI 4.2-10.5]). Meta-regression suggested that bipolar radiofrequency energy and thoracoscopic access were associated with greater efficacy, but adjusting for these factors did not unmask any difference between epicardial-alone and hybrid ablation. Hybrid and epicardial ablation alone appear to be equally effective treatments for AF, although hybrid ablation may be associated with higher complication rates. These data derived from observational studies should be verified with randomised data.
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Affiliation(s)
- Charles M Pearman
- Department of Cardiology, Liverpool Heart and Chest Hospital.,Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester
| | - Shi S Poon
- Department of Cardiology, Liverpool Heart and Chest Hospital
| | | | - Shouvik Haldar
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science,Imperial College London, UK
| | - Tom Wong
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science,Imperial College London, UK
| | - Neeraj Mediratta
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital
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24
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Osmancik P, Budera P. To the Editor- Perioperative anticoagulation management during thoracoscopic ablation. Heart Rhythm 2016; 14:e47. [PMID: 27890736 DOI: 10.1016/j.hrthm.2016.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Pavel Osmancik
- Cardiocenter, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
| | - Petr Budera
- Cardiocenter, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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25
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Romanov A, Pokushalov E, Losik D, Steinberg JS. Reply to the Editor-Perioperative anticoagulation management during thoracoscopic ablation. Heart Rhythm 2016; 14:e47. [PMID: 27890737 DOI: 10.1016/j.hrthm.2016.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Alexander Romanov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia.
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Denis Losik
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
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26
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de Groot JR, van Boven WJP, Driessen AHG. To the Editor- Ganglionic plexus ablation in advanced atrial fibrillation. Heart Rhythm 2016; 13:e331. [PMID: 27574984 DOI: 10.1016/j.hrthm.2016.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Wim Jan P van Boven
- Department of Cardiothoracic Surgery Academic Medical Center Amsterdam, The Netherlands
| | - Antoine H G Driessen
- Department of Cardiothoracic Surgery Academic Medical Center Amsterdam, The Netherlands
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27
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Romanov A, Pokushalov E, Steinberg JS. Reply to the Editor-Ganglionic Plexus Ablation in Advanced Atrial Fibrillation. Heart Rhythm 2016; 13:e331. [PMID: 27590434 DOI: 10.1016/j.hrthm.2016.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Romanov
- State Research Institute of Circulation Pathology Novosibirsk, Russia.
| | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology Novosibirsk, Russia
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