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Kaur H, Tao B, Silverman M, Healey JS, Belley-Cote EP, Islam S, Whitlock RP, Devereaux PJ, Conen D, Bidar E, Kawczynski M, Ayala-Paredes F, Ayala-Valani LM, Sandgren E, El-Chami MF, Jørgensen TH, Thyregod HGH, Sabbag A, McIntyre WF. Recurrence of new-onset post-operative AF after cardiac surgery: detected by implantable loop recorders: A systematic review and Meta-analysis. Int J Cardiol 2024; 404:131930. [PMID: 38447764 DOI: 10.1016/j.ijcard.2024.131930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. New-onset post-operative AF may signal an elevated risk of AF and associated outcomes in long-term follow-up. We aimed to estimate the rate of AF recurrence as detected by an implantable loop recorder (ILR) in patients experiencing post-operative AF within 30 days after cardiac surgery. METHODS We searched MEDLINE, Embase and Cochrane CENTRAL to April 2023 for studies of adults who did not have known AF, experienced new-onset AF within 30 days of cardiac surgery and received an ILR. We pooled individual participant data on timing of AF recurrence using a random-effects model with a frailty model applied to a Cox proportional hazard analysis. RESULTS From 8671 citations, 8 single-centre prospective cohort studies met eligibility criteria. Data were available from 185 participants in 7 studies, with a median follow-up of 1.7 (IQR: 1.3-2.8) years. All included studies were at a low risk of bias. Pooled AF recurrence rates following 30 post-operative days were 17.8% (95% CI 11.9%-23.2%) at 3 months, 24.4% (17.7%-30.6%) at 6 months, 30.1% (22.8%-36.7%) at 12 months and 35.3% (27.6%-42.2%) at 18 months. CONCLUSIONS In patients who experience new-onset post-operative AF after cardiac surgery, AF recurrence lasting at least 30 s occurs in approximately 1 in 3 in the first year after surgery. The optimal frequency and modality to use for monitoring for AF recurrence in this population remain uncertain.
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Affiliation(s)
- Hargun Kaur
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Brendan Tao
- University of British Columbia, British Columbia, Canada
| | - Max Silverman
- Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | | | | | | | | | | | - David Conen
- Population Health Research Institute, Ontario, Canada
| | - Elham Bidar
- Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; CardioVascular Research Institute Maastricht (CARIM), the Netherlands
| | - Michal Kawczynski
- Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; CardioVascular Research Institute Maastricht (CARIM), the Netherlands
| | | | | | - Emma Sandgren
- Department of Medicine, Halland Hospital Varberg, Varberg, Sweden
| | - Mikhael F El-Chami
- Department of Medicine, Emory University School of Medicine, Atlanta, United States of America
| | | | | | - Avi Sabbag
- Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan and the Faculty of Median, Tel-Aviv University, Israel
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van der Heijden CAJ, Aerts L, Chaldoupi SM, van Cruchten C, Kawczynski M, Heuts S, Bidar E, Luermans JGLM, Maesen B. Hybrid atrial fibrillation ablation. Ann Cardiothorac Surg 2024; 13:54-70. [PMID: 38380145 PMCID: PMC10875200 DOI: 10.21037/acs-2023-afm-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 02/22/2024]
Abstract
In this state-of-the art review on hybrid atrial fibrillation (AF) ablation, we briefly focus on the pathophysiology of AF, the rationale for the hybrid approach, its technical aspects and the efficacy and safety outcomes after hybrid AF ablation, both from meta-analyses and randomized control trial data. Also, we performed a systematic search to provide a provisional overview of real-world hybrid AF ablation efficacy and safety outcomes. Furthermore, we give an insight into the 'Maastricht approach', an approach that allows us to tailor the ablation procedure to the individual patient. Finally, we reflect on future perspectives with the objective to continue improving our thoracoscopic hybrid AF ablation approach. Based on the review of the available literature, we believe it is fair to state that thoracoscopic hybrid AF ablation is a valid alternative to catheter ablation for the treatment of patients with more persistent forms of AF.
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Affiliation(s)
| | - Luca Aerts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sevasti-Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Cas van Cruchten
- Department of Plastic Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - Michal Kawczynski
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Justin G. L. M. Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
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Winters J, Isaacs A, Zeemering S, Kawczynski M, Maesen B, Maessen J, Bidar E, Boukens B, Hermans B, van Hunnik A, Casadei B, Fabritz L, Chua W, Sommerfeld L, Guasch E, Mont L, Batlle M, Hatem S, Kirchhof P, Wakili R, Sinner M, Stoll M, Goette A, Verheule S, Schotten U. Heart Failure, Female Sex, and Atrial Fibrillation Are the Main Drivers of Human Atrial Cardiomyopathy: Results From the CATCH ME Consortium. J Am Heart Assoc 2023; 12:e031220. [PMID: 37982389 PMCID: PMC10727294 DOI: 10.1161/jaha.123.031220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/22/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Atrial cardiomyopathy (atCM) is an emerging prognostic factor in cardiovascular disease. Fibrotic remodeling, cardiomyocyte hypertrophy, and capillary density are hallmarks of atCM. The contribution of etiological factors and atrial fibrillation (AF) to the development of differential atCM phenotypes has not been quantified. This study aimed to evaluate the association between histological features of atCM and the clinical phenotype. METHODS AND RESULTS We examined left atrial (LA, n=95) and right atrial (RA, n=76) appendages from a European cohort of patients undergoing cardiac surgery. Quantification of histological atCM features was performed following wheat germ agglutinin/CD31/vimentin staining. The contributions of AF, heart failure, sex, and age to histological characteristics were determined with multiple linear regression models. Persistent AF was associated with increased endomysial fibrosis (LA: +1.13±0.47 μm, P=0.038; RA: +0.94±0.38 μm, P=0.041), whereas total extracellular matrix content was not. Men had larger cardiomyocytes (LA: +1.92±0.72 μm, P<0.001), while women had more endomysial fibrosis (LA: +0.99±0.56 μm, P=0.003). Patients with heart failure showed more endomysial fibrosis (LA: +1.85±0.48 μm, P<0.001) and extracellular matrix content (LA: +3.07±1.29%, P=0.016), and a higher capillary density (LA: +0.13±0.06, P=0.007) and size (LA: +0.46±0.22 μm, P=0.044). Fuzzy k-means clustering of histological features identified 2 subtypes of atCM: 1 characterized by enhanced endomysial fibrosis (LA: +3.17 μm, P<0.001; RA: +2.86 μm, P<0.001), extracellular matrix content (LA: +3.53%, P<0.001; RA: +6.40%, P<0.001) and fibroblast density (LA: +4.38%, P<0.001), and 1 characterized by cardiomyocyte hypertrophy (LA: +1.16 μm, P=0.008; RA: +2.58 μm, P<0.001). Patients with fibrotic atCM were more frequently female (LA: odds ratio [OR], 1.33, P=0.002; RA: OR, 1.54, P=0.004), with persistent AF (LA: OR, 1.22, P=0.036) or heart failure (LA: OR, 1.62, P<0.001). Hypertrophic features were more common in men (LA: OR=1.33, P=0.002; RA: OR, 1.54, P=0.004). CONCLUSIONS Fibrotic atCM is associated with female sex, persistent AF, and heart failure, while hypertrophic features are more common in men.
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Affiliation(s)
- Joris Winters
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Aaron Isaacs
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
- Maastricht Centre for Systems Biology University Maastricht Maastricht The Netherlands
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Michal Kawczynski
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
- Department of Cardiothoracic Surgery Maastricht University Medical Centre+ Maastricht The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery Maastricht University Medical Centre+ Maastricht The Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery Maastricht University Medical Centre+ Maastricht The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery Maastricht University Medical Centre+ Maastricht The Netherlands
| | - Bas Boukens
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Ben Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Arne van Hunnik
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence University of Oxford Oxford United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences Birmingham United Kingdom
- University Center of Cardiovascular Science UKE Hamburg Hamburg Germany
- University Heart and Vascular Center, University Hospital Hamburg Eppendorf Hamburg Germany
- DZHK, Standort Hamburg/Kiel/Lübeck Lübeck Germany
| | - Winnie Chua
- Institute of Cardiovascular Sciences Birmingham United Kingdom
| | - Laura Sommerfeld
- Institute of Cardiovascular Sciences Birmingham United Kingdom
- University Center of Cardiovascular Science UKE Hamburg Hamburg Germany
- University Heart and Vascular Center, University Hospital Hamburg Eppendorf Hamburg Germany
- DZHK, Standort Hamburg/Kiel/Lübeck Lübeck Germany
| | - Eduard Guasch
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS) Barcelona Spain
| | - Luis Mont
- Clinic Barcelona, Universitat de Barcelona Barcelona Spain
| | - Montserrat Batlle
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS) Barcelona Spain
- Centro de Investigación Biomédica en Red-Cardiovascular (CIBERCV) Madrid Spain
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences Birmingham United Kingdom
- University Heart and Vascular Center, University Hospital Hamburg Eppendorf Hamburg Germany
- DZHK, Standort Hamburg/Kiel/Lübeck Lübeck Germany
| | - Reza Wakili
- Department of Medicine and Cardiology Goethe University Frankfurt Germany
| | - Mortiz Sinner
- University Heart and Vascular Center, University Hospital Hamburg Eppendorf Hamburg Germany
- DZHK, Standort Hamburg/Kiel/Lübeck Lübeck Germany
- Department of Cardiology University Hospital of Munich Munich Germany
| | - Monica Stoll
- Maastricht Centre for Systems Biology University Maastricht Maastricht The Netherlands
- Department of Biochemistry, Genetic Epidemiology and Statistical Genetics University Maastricht Maastricht The Netherlands
- Department of Genetic Epidemiology, Institute of Human Genetics University of Münster Münster Germany
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz Hospital Paderborn Paderborn Germany
| | - Sander Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht Maastricht The Netherlands
- Department of Cardiology Maastricht University Medical Centre+ Maastricht The Netherlands
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Zeemering S, Isaacs A, Winters J, Isaacs A, Kawczynski M, Rivero MH, Ghalawinji A, Witten A, Chua W, Kaab S, Wakili R, Sinner MF, Mont L, Guasch E, Hatem S, Crijns HJ, Fabritz L, Kirchhof P, Stoll M, Schotten U. BS-515-04 REPLICATED GENE EXPRESSION CHANGES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gilbers MD, Kawczynski M, Winters J, Isaacs A, Bidar E, Zeemering S, Van Gelder IC, Crijns HJ, Verheule S, Stoll M, Schotten U. PO-715-07 CORRELATIONS BETWEEN BIOMARKERS AND ENDOMYSIAL FIBROSIS IN LEFT AND RIGHT ATRIA OF PATIENTS UNDERGOING CARDIAC SURGERY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kawczynski M, Gilbers MD, Bidar E, Winters J, Zeemering S, Verheule S, Isaacs A, Maesen B, Crijns HJ, Van Gelder IC, Schotten U. PO-700-03 CORRELATION BETWEEN ATRIAL FUNCTION, BLOOD BIOMARKERS, AND HISTOLOGICAL PARAMETERS IN PATIENTS UNDERGOING CARDIAC SURGERY WITHOUT HISTORY OF ATRIAL ARRHYTHMIAS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Bidar E, Zeemering S, Gilbers M, Isaacs A, Verheule S, Zink MD, Maesen B, Bramer S, Kawczynski M, Van Gelder IC, Crijns HJGM, Maessen JG, Schotten U. Clinical and electrophysiological predictors of device-detected new-onset atrial fibrillation during 3 years after cardiac surgery. Europace 2021; 23:1922-1930. [PMID: 34198338 PMCID: PMC8651165 DOI: 10.1093/europace/euab136] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Aims Postoperative atrial fibrillation (POAF) after cardiac surgery is an independent predictor of stroke and mortality late after discharge. We aimed to determine the burden and predictors of early (up to 5th postoperative day) and late (after 5th postoperative day) new-onset atrial fibrillation (AF) using implantable loop recorders (ILRs) in patients undergoing open chest cardiac surgery. Methods and results Seventy-nine patients without a history of AF undergoing cardiac surgery underwent peri-operative high-resolution mapping of electrically induced AF and were followed 36 months after surgery using an ILR (Reveal XT™). Clinical and electrophysiological predictors of late POAF were assessed. POAF occurred in 46 patients (58%), with early POAF detected in 27 (34%) and late POAF in 37 patients (47%). Late POAF episodes were short-lasting (mostly between 2 min and 6 h) and showed a circadian rhythm pattern with a peak of episode initiation during daytime. In POAF patients, electrically induced AF showed more complex propagation patterns than in patients without POAF. Early POAF, right atrial (RA) volume, prolonged PR time, and advanced age were independent predictors of late POAF. Conclusions Late POAF occurred in 47% of patients without a history of AF. Patients who develop early POAF, with higher age, larger RA, or prolonged PR time have a higher risk of developing late POAF and may benefit from intensified rhythm follow-up after cardiac surgery. Clinicaltrials.gov number NCT01530750.
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Affiliation(s)
- Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202 AZMaastricht, The Netherlands.,Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Stef Zeemering
- Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Martijn Gilbers
- Department of Physiology, Maastricht University, The Netherlands
| | - Aaron Isaacs
- Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Sander Verheule
- Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Matthias D Zink
- Department of Physiology, Maastricht University, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202 AZMaastricht, The Netherlands.,Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Sander Bramer
- Department of Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Michal Kawczynski
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202 AZMaastricht, The Netherlands.,Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Harry J G M Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202 AZMaastricht, The Netherlands.,Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Physiology, Maastricht University, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Heuts S, Kawczynski M, Olsthoorn JR, Sardari Nia P. Late rupture of transapically beating heart implanted neochords. J Thorac Cardiovasc Surg 2019; 157:e27-e29. [DOI: 10.1016/j.jtcvs.2018.07.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
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