Rationale for minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation

Systematic review and meta-analysis of surgical ablation for atrial fibrillation during mitral valve surgery

BACKGROUND

Surgical ablation has emerged as an acceptable treatment modality for patients with atrial fibrillation (AF) undertaking concomitant cardiac surgery. However, the efficacy of surgical ablation in patient populations undergoing mitral valve surgery is not well established. The present meta-analysis aims to establish the current randomized evidence on clinical outcomes of surgical ablation versus no ablative treatment in patients with AF undergoing mitral valve surgery.

METHODS

Electronic searches were performed using six databases from their inception to September 2013, identifying all relevant randomized controlled trials (RCTs) comparing surgical ablation versus no ablation in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints.

RESULTS

Nine relevant RCTs were identified for inclusion in the present analysis. The number of patients in sinus rhythm (SR) was significantly improved in the surgical ablation group compared to the non-ablation group at discharge. This effect on SR remained at all follow-up periods until >1 year. Results indicated that there was no significant difference between surgical ablation and no ablation in terms of 30-day mortality, all-cause mortality, pacemaker implantation, stroke, thromboembolism, cardiac tamponade, reoperation for bleeding and myocardial infarction.

CONCLUSIONS

Results from the present meta-analysis demonstrate that the addition of surgical ablation for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke and thromboembolism. Further research should be directed at correlating different surgical ablation subtypes to cardiac and cerebrovascular events at long-term follow-up.

Totally Thoracoscopic Surgical Ablation or Catheter Ablation of Atrial Fibrillation: A Systematic Review and Preliminary Meta-Analysis

This article provides results of a preliminary meta-analysis of the stand-alone atrial fibrillation (AF) surgical publications from 2009 to 2011. In 6 studies with postoperative freedom from AF as primary end point, the meta-analysis indicated an overall success rate of 84% (95% confidence interval [CI], 80.0-88.0). For the 7 studies with the primary end point of postoperative return to normal sinus rhythm, the success rate was 83% (95% CI, 79.0-87.0). These data are compared with 3 comprehensive meta-analyses of catheter ablation. Based on comparison, it is recommended that initial treatment of long-standing persistent atrial fibrillation be minimal access surgery.