scholarly journals Does Preoperative Sinus Rhythm Influence Surgical Ablation’s Perioperative Safety in Patients with Atrial Fibrillation?

2021 ◽  
Vol 24 (5) ◽  
pp. E785-E793
Author(s):  
Maximilian Vondran ◽  
Tamer Ghazy ◽  
Marc Albert ◽  
Henning Warnecke ◽  
Mirko Doss ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Perioperative Complications ◽  
Pacemaker Implantation ◽  
Implantation Rate ◽  
Heart Rhythm ◽  
Surgical Ablation ◽  
Entire Cohort ◽  
Ablation Therapy

Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, currently, only 25–40% of atrial fibrillation (AF) patients undergo simultaneous surgical ablation therapy (SA) during cardiac surgery. Surgeon’s fear exposing their patients to an additional, unjustified, and disproportionate risk when performing SA in AF patients presenting with sinus rhythm (SR) before surgery. To clarify the influence of preoperative SR before SA for AF, we conducted a subgroup analysis of the German Cardiosurgical Atrial Fibrillation (CASE-AF) register. Methods: Between September 2016 and August 2020, 964 AF patients with an underlying cardiac disease were scheduled for surgery with SA and enrolled in the CASE-AF register. Data prospectively were collected and analyzed retrospectively. We divided the entire cohort into an SR-group (38.2%, N = 368) and an AF-group (61.8%, N = 596), based on preoperative heart rhythm. Results: Over half of the patients were moderately affected by their AF, with no difference between the groups (European Heart Rhythm Association class ≥IIb: SR-group 54.2% versus AF-group 58.5%, P = .238). The AF-group had a higher preoperative EuroSCORE II (4.8 ± 8.0% versus 4.2 ± 6.3%, P = .014). In-hospital mortality (SR-group 0.8% versus AF-group 1.7%, P = .261), major perioperative adverse cardiac and cerebrovascular events (SR-group 2.7% versus AF-group 3.5%, P = .500), and the new pacemaker implantation rate (SR-group 6.0% versus AF-group 5.9%, P = .939) were low and showed and no group difference. Logistic regression analysis showed a protective effect for preoperative SR to perioperative complications in AF patients undergoing SA (odds ratio (OR) 0.72 (95% CI 0.52 - 0.998); P = .0485). Conclusions: Concomitant SA in AF patients presenting in SR before cardiac surgery is safe, has a low perioperative risk profile, and should be carried out with almost no exceptions.

Surgical Ablation for Atrial Fibrillation in Cardiac Surgery a Meta-Analysis and Systematic Review

2010 ◽  
Vol 5 (2) ◽  
pp. 84-96 ◽  
Author(s):  
Davy C. H. Cheng ◽  
Niv Ad ◽  
Janet Martin ◽  
Eva E. Berglin ◽  
Byung-Chul Chang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Resource Utilization ◽  
Meta Analysis ◽  
Surgical Ablation ◽  
Af Ablation ◽  
All Cause Mortality ◽  
Meta Regression

Objectives This meta-analysis sought to determine whether surgical ablation improves clinical outcomes and resource utilization compared with no ablation in adult patients with persistent and permanent atrial fibrillation (AF) undergoing cardiac surgery. Methods A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials of surgical ablation versus no ablation in patients with AF undergoing cardiac surgery up to April 2009. The primary outcome was sinus rhythm. Secondary outcomes included survival and any other reported clinically relevant outcome or indicator of resource utilization. Odds ratios (OR) and weighted mean differences (WMD) and their 95% confidence intervals (95% CI) were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Meta-regression was performed to explore the relationship between the benefit from surgical AF and duration of follow-up. Results Thirty-three studies met the inclusion criteria (10 RCTs and 23 non-RCTs) for a total of 4647 patients. The number of patients in sinus rhythm was significantly improved at discharge in the surgical AF ablation group versus (68.6%) the surgery alone group (23.0%) in RCTs (OR 10.1, 95% CI 4.5–22.5) and non-RCTs (OR 7.15, 95% CI 3.42–14.95). This effect on sinus rhythm (74.6% vs. 18.4%) remained at follow-up of 1 to 5 years (OR 6.7, 95% CI 2.8–15.7 for RCT, and OR 15.5, 95% CI 6.6–36.7 for non-RCT). The risk of all-cause mortality at 30 days was not different between the groups in RCT (OR 1.20, 95% CI 0.52–3.16) or non-RCT studies (OR 0.99, 95% CI 0.52–1.87). In studies reporting all-cause mortality at 1 year or more (up to 5 years), mortality did not differ in RCT studies (OR 1.21, 95% CI 0.59–2.51) but was significantly reduced in non-RCT studies (OR 0.54, 95% CI 0.31–0.96). Stroke incidence was not reduced significantly; however, in meta-regression, the risk of stroke decreased significantly with longer follow-up. Other clinical outcomes were similar between groups. Operation time was significantly increased with surgical AF ablation; however, overall impact on length of stay was variable. Conclusions In patients with persistent or permanent AF who present for cardiac surgery, the addition of surgical AF ablation led to a significantly higher rate of sinus rhythm in RCT and non-RCT studies compared with cardiac surgery alone, and this effect remains robust over the longer term (1–5 years). Although non-RCT studies suggest the possibility of reduced risk of stroke and death, this remains to be proven in prospective RCTs with adequate power and follow-up.

Successful Treatment of Lone Persistent Atrial Fibrillation by Means of a Hybrid Thoracoscopic-Transcatheter Approach

2012 ◽  
Vol 7 (4) ◽  
pp. 254-258 ◽  
Author(s):  
Claudio Muneretto ◽  
Gianluigi Bisleri ◽  
Luca Bontempi ◽  
Faisal H. Cheema ◽  
Antonio Curnis
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Hybrid Approach ◽  
Heart Rhythm ◽  
Persistent Atrial Fibrillation ◽  
Surgical Approaches ◽  
Surgical Ablation ◽  
Internally Cooled ◽  
The Mean

Objective Ablation strategies for the treatment of lone persistent atrial fibrillation (AF) have rapidly evolved during the past decade both with electrophysiological (EP) and surgical approaches. We investigated the safety and efficacy of a novel staged hybrid approach combining surgical thoracoscopic and EP ablation in patients with lone persistent AF. Methods Twenty-four consecutive patients with either persistent (three patients, 12.5%) or long-standing persistent (21 patients, 87.5%) isolated AF were prospectively enrolled: the mean age was 63.2 ± 9.3 years, the mean left atrial dimension was 50.5 ± 8 mm, and the mean AF duration was 82.7 months (range, 7–240 months). The surgical procedure consisted of a monolateral, right-sided, thoracoscopic closed-chest approach to perform a “box” lesion set with a temperature-controlled, internally cooled, radiofrequency monopolar device with suction adherence (Cobra Adhere XL; Estech, San Ramon, CA USA). A continuous monitoring rhythm device (Reveal XT; Medtronic, Minneapolis, MN USA) was implanted at the time of surgery in all patients for continuous long-term monitoring of the heart rhythm. Results Successful completion of the procedure was achieved in all cases, with a mean ablation time of 29 ± 9 minutes and an overall procedural time of 84 ± 16 minutes. After surgical ablation, the exit block was documented in all cases, whereas the entrance block was achieved in 87.5% (21 of 24 patients). No intensive care unit stay was required, and no complications occurred postoperatively; hospital mortality was 0%. At a mean interval of 33 ± 2 days after surgery, an EP study was performed: bidirectional block was confirmed in 79.1% (19 of 24 patients), whereas gaps at the level of the box lesion were observed in 20.8% of the patients (5 of 24 patients). Additional transcatheter endocardial right- and left-sided lesions were performed in 62.5% of cases (15 of 24 patients). At a mean follow-up of 28 months (range, 1–55 months), 87.5% of the patients (21 of 24 patients) are in sinus rhythm, and the incidence of left atrial flutter was 0%. Conclusions The combination of thoracoscopic box lesion and transcatheter ablation in a staged hybrid approach proved to be safe, providing excellent mid-term clinical outcomes in patients with long-standing, isolated, persistent AF. Moreover, the implantable loop recorders documented such incremental benefits in sinus rhythm restoration for up to 28 months.

Long-term Monitoring for Patients after Surgical Ablation of Atrial Fibrillation Are All Devices the Same?

2010 ◽  
Vol 5 (4) ◽  
pp. 259-264 ◽  
Author(s):  
Linda Henry ◽  
Niv Ad
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Monitoring Program ◽  
Heart Rhythm ◽  
Ease Of Use ◽  
External Support ◽  
Surgical Ablation ◽  
Asymptomatic Patients ◽  
Consistent Method ◽  
The Right

In recent years, the nonmedical management of atrial fibrillation (AF) has rapidly evolved, with more options available to address the arrhythmia. Determining the successful return of sinus rhythm and the medical management after ablation requires the selection of the correct diagnostic method. In May 2007, the Heart Rhythm Society in conjunction with the Society for Thoracic Surgeons, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society identified the need for programs to adopt a consistent method of follow-up and monitoring. Choosing the right monitor for the determination of the success, postsurgical ablation that meets the Heart Rhythm Society guidelines for monitoring especially for asymptomatic patients is imperative. Therefore, we reviewed the current devices available to assist practitioners in determining which monitor best meets their needs The criteria selected to perform the review include (1) ease of use for patients (compliance), (2) ability of the monitor to perform internal analysis, (3) the monitor has >24 hours of storage capability, and (4) external support. Our selection criteria revealed six cardiac rhythm monitors currently available for use. This review compared the different arrhythmia monitors from an established monitoring program perspective to assist practitioners in choosing a monitor that meets their practice needs for determining the return to sinus rhythm postsurgical ablation.

Risk scoring by CHADS2 and CHA2DS2-VASc as predictors for long-term outcomes after surgical ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Lauritzen ◽  
H.J Vodstrup ◽  
T.D Christensen ◽  
M Onat ◽  
R Christensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Isolation Procedure ◽  
Survival Times ◽  
Long Term Outcomes ◽  
Surgical Ablation ◽  
Follow Up Study ◽  
Risk Scoring

Abstract Background Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation. Purpose To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery. Methods In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019. Results A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p<0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p<0.001. Conclusion Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death. Survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Kardia Mobile and ISTEL HR applicability in clinical practice: A comparison of Kardia Mobile, ISTEL HR and standard 12-lead electrocardiogram records in 98 consecutive patients of a tertiary cardiovascular care centre

2021 ◽  
Author(s):  
Bartosz Krzowski ◽  
Kamila Skoczylas ◽  
Gabriela Osak ◽  
Natalia Żurawska ◽  
Michał Peller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Cardiovascular Diseases ◽  
Sinus Rhythm ◽  
Sensitivity And Specificity ◽  
Heart Rhythm ◽  
Everyday Practice ◽  
Portable Devices ◽  
Care Centre ◽  
Cardiovascular Care

Abstract Aims Mobile, portable ECG-recorders allow the assessment of heart rhythm in out-of-hospital conditions and may prove useful for monitoring patients with cardiovascular diseases. However, the effectiveness of these portable devices has not been tested in everyday practice. Methods and results A group of 98 consecutive cardiology patients (62 males [63%], mean age 69 ± 12.9 years) were included in an academic care centre. For each patient, a standard 12-lead electrocardiogram (SE), as well as a Kardia Mobile 6L (KM) and Istel (IS) HR-2000 ECG were performed. Two groups of experienced physycians analyzed obtained recordings. After analyzing ECG tracings from SE, KM, and IS, quality was marked as good in 82%, 80%, and 72% of patients, respectively (p < 0.001). There were no significant differences between devices in terms of detecting sinus rhythm (SE [60%, n = 59], KM [58%, n = 56], and IS [61%, n = 60]; SE vs KM p = 0.53; SE vs IS p = 0.76) and atrial fibrillation (SE [22%, n = 22], KM [22%, n = 21], and IS [18%, n = 18]; (SE vs KM p = 0.65; SE vs IS = 0.1). KM had a sensitivity of 88.1% and a specificity of 89.7% for diagnosing sinus rhythm. IS showed 91.5% and 84.6% sensitivity and specificity, respectively. The sensitivity of KM in detecting atrial fibrillation was higher than IS (86.4% vs. 77.3%), but their specificity was comparable (97.4% vs. 98.7%). Conclusion Novel, portable devices are useful in showing sinus rhythm and detecting atrial fibrillation in clinical practice. However, ECG measurements concerning conduction and repolarisation should be clarified with a standard 12-lead electrocardiogram.

Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

2021 ◽  
Author(s):  
Sara Rita Vacirca
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Surgical Ablation ◽  
Before And After ◽  
The Mean ◽  
Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

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