scholarly journals Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

2021 ◽  
Vol 11 (1) ◽  
pp. 210
Author(s):  
Patrick M. McCarthy ◽  
James L. Cox ◽  
Olga N. Kislitsina ◽  
Jane Kruse ◽  
Andrei Churyla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Current Practice ◽  
Interventional Therapy ◽  
Western World ◽  
Surgical Ablation ◽  
Future Directions ◽  
Aggressive Approach ◽  
The Past ◽  
Oral Medications

Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including catheter ablation and surgical ablation. The increasing prevalence and the morbidity/mortality associated with AF warrants a more aggressive approach to its treatment. It is the purpose of this invited editorial to describe the past, present, and anticipated future directions of the interventional therapy of AF, and to crystallize the problems that remain.

scholarly journals B-PO01-058 CATHETER ABLATION VS SURGICAL ABLATION IN ATRIAL FIBRILLATION: ANALYSIS OF NATIONAL INPATIENT SAMPLE, 2004-2018

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S74
Author(s):  
Abdul Mannan Khan Minhas ◽  
Salik Nazir ◽  
Muhammad Hisham Wazir ◽  
Muhammad Osama Muslim
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
National Inpatient Sample ◽  
Surgical Ablation

Rhythm control: surgical ablation

ESC CardioMed ◽  
2018 ◽  
pp. 2173-2177
Author(s):  
Chawannuch Ruaengsri ◽  
Matthew R. Schill ◽  
Richard B. Schuessler ◽  
Ralph J. Damiano
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Option ◽  
Surgical Procedures ◽  
Antiarrhythmic Drugs ◽  
Cardiac Surgical Procedures ◽  
Rhythm Control ◽  
Maze Procedure ◽  
Hybrid Procedures ◽  
Surgical Ablation

Surgical ablation for atrial fibrillation was introduced in 1987 and has since become well established as a treatment option for patients with symptomatic atrial fibrillation refractory to antiarrhythmic drugs and/or catheter ablation or patients who are having concomitant cardiac surgical procedures. The Cox–Maze procedure has been improved upon by modern variations using ablation devices. More limited ablation procedures and hybrid procedures have been introduced, but their efficacy requires further investigation.

scholarly journals Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiangang Wang ◽  
Songnan Li ◽  
Qing Ye ◽  
Xiaolong Ma ◽  
Yichen Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tricuspid Regurgitation ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Group Analysis ◽  
Tricuspid Valve Repair ◽  
Surgical Ablation ◽  
Severe Tricuspid Regurgitation ◽  
Recurrent Atrial Fibrillation

Abstract Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95–97.78) and 92.0% (95% CI: 85.26–95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan–Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

scholarly journals Thoracoscopic surgical ablation or catheter ablation for patients with atrial fibrillation? A systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 31 (6) ◽  
pp. 763-773
Author(s):  
Shaolei Yi ◽  
Xiaojun Liu ◽  
Wei Wang ◽  
Lianghua Chen ◽  
Haitao Yuan
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Invasive Procedure ◽  
Controlled Trials ◽  
Surgical Ablation ◽  
Randomized Controlled

Abstract OBJECTIVES There is an urgent need to understand the difference in the influence of thoracoscopic surgical ablation (TSA) and catheter ablation (CA) on clinical outcomes in patients with atrial fibrillation (AF). This meta-analysis of randomized controlled trials aimed to examine the efficacy and safety of TSA versus CA in patients with AF. METHODS Databases including EMBASE, Clinical Trials, PubMed and Cochrane Central Registered Control System were screened for the retrieval of articles. A direct meta-analysis of TSA versus CA was conducted. The I2 test analysis was performed to evaluate heterogeneity. The Begg–Mazumdar test and the Harbord–Egger test were used to detect publication bias. The primary efficacy outcome was freedom from atrial tachyarrhythmia, while the primary safety outcome was severe adverse event (SAE) occurrence. RESULTS Of the 860 identified articles, 6, comprising 466 participants, were finally included. The rate of freedom from AT was higher in the TSA group (75%) than in the CA group (57.1%) (odds ratio 0.41; 95% confidence interval 0.2–0.85; P = 0.02; I2 = 57%). A larger number of SAEs were observed in the TSA group than in the CA group (odds ratio 0.16; 95% confidence interval 0.006–0.46; P = 0.0006; I2 = 44%). The result of the subgroup analysis of 3 studies that enrolled AF patients without a history of ablation showed that the incidence of AT was comparable in both arms. The ablation procedure and hospitalization durations were longer in the TSA arm. CONCLUSIONS In our study, TSA was associated with better efficacy but a higher rate of SAEs compared to CA. In addition, TSA did not show better efficacy results as the first invasive procedure in the sub-analysis of patients with paroxysmal AF or early persistent AF. Therefore, doctors should recommend either TSA or CA to patients with AF after due consideration of the aforementioned findings.

Energy Sources for the Surgical Treatment of Atrial Fibrillation

2019 ◽  
Vol 14 (6) ◽  
pp. 503-508
Author(s):  
Robert M. MacGregor ◽  
Spencer J. Melby ◽  
Richard B. Schuessler ◽  
Ralph J. Damiano
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Tissue Injury ◽  
Surgical Techniques ◽  
Maze Procedure ◽  
Energy Sources ◽  
Surgical Approaches ◽  
Surgical Ablation ◽  
The Past ◽  
Minimally Invasive Surgical

The surgical treatment of atrial fibrillation has evolved over the past 2 decades due to the advent of ablation technology, and the introduction of less invasive surgical approaches. Current devices produce ablation lines that aim to replace the incisions of traditional surgical ablation strategies, such as the Cox-Maze procedure. This has helped to simplify and shorten surgical ablation procedures and has allowed for the development of minimally invasive surgical techniques. This review discusses surgical ablation energy sources and devices, providing background on device characteristics, mechanism of tissue injury, and success in creating transmural lesions.

scholarly journals Epicardial and Endocardial Validation of Conduction Block After Thoracoscopic Epicardial Ablation of Atrial Fibrillation

2020 ◽  
Vol 15 (6) ◽  
pp. 525-531
Author(s):  
Mindy Vroomen ◽  
Bart Maesen ◽  
Justin L. Luermans ◽  
Jos G. Maessen ◽  
Harry J. Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Conduction Block ◽  
Epicardial Ablation ◽  
Surgical Ablation ◽  
Tissue Edema ◽  
Block Based ◽  
The Right ◽  
Positive Results

Objective It is unknown whether epicardial and endocardial validation of bidirectional block after thoracoscopic surgical ablation for atrial fibrillation is comparable. Epicardial validation may lead to false-positive results due to epicardial tissue edema, and thus could leave gaps with subsequent arrhythmia recurrence. It is the aim of the present study to answer this question in patients who underwent hybrid atrial fibrillation ablation (combined thoracoscopic epicardial and endocardial catheter ablation). Methods After epicardial ablation of the pulmonary veins (PVs) and connecting inferior and roof lines (box lesion), exit and entrance block were epicardially and endocardially evaluated using an endocardial His Bundle catheter and electrophysiological workstation. If incomplete lesions were found, endocardial touch-up ablation was performed. Validation results were also compared to predictions about conduction block based on tissue conductance measurements of the epicardial ablation device. Results Twenty-five patients were included. Epicardial validation results were 100% equal to the endocardial results for the left superior, left inferior, and right inferior PVs and box lesion. For the right superior PV, 85% similarity was found. Based on tissue conductance measurements, 139 lesions were expected to be complete; however, in 5 (3.6%) a gap was present. Conclusions Epicardial bidirectional conduction block in the PVs and the box lesion corresponded well with endocardial bidirectional conduction block. Conduction block predictions by changes in tissue conductance failed in few cases compared to block confirmation. This emphasizes that tissue conduction measurements can provide a rough indication of lesion effectiveness but needs endpoint confirmation by either epicardial or endocardial block testing.

scholarly journals Catheter Ablation or Surgical Therapy in Moderate-Severe Tricuspid Regurgitation Caused by Long-standing Persistent Atrial Fibrillation. Propensity Score Analysis

2020 ◽  
Author(s):  
Jiangang Wang ◽  
Songnan Li ◽  
Qing Ye ◽  
Xiaolong Ma ◽  
Yichen Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tricuspid Regurgitation ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Group Analysis ◽  
Tricuspid Valve Repair ◽  
Surgical Ablation ◽  
Severe Tricuspid Regurgitation ◽  
Recurrent Atrial Fibrillation

Abstract Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6mm and >= 6mm. Kaplan–Meier analysis showed in patients with tethering height < 6mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height >= 6mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

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