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Wyler von Ballmoos MC, Hui DS, Mehaffey JH, Malaisrie SC, Vardas PN, Gillinov AM, Sundt TM, Badhwar V. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2024; 118:291-310. [PMID: 38286206 DOI: 10.1016/j.athoracsur.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation incorporate the most recent evidence for surgical ablation and left atrial appendage occlusion in different clinical scenarios. Substantial new evidence regarding the risks and benefits of surgical left atrial appendage occlusion and the long-term benefits of surgical ablation has been produced in the last 5 years. Compared with the 2017 clinical practice guideline, the current update has an emphasis on surgical ablation in first-time, nonemergent cardiac surgery and its long-term benefits, an extension of the recommendation to perform surgical ablation in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery, and a new class I recommendation for left atrial appendage occlusion in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery. Further guidance is provided for patients with structural heart disease and atrial fibrillation being considered for transcatheter valve repair or replacement, as well as patients in need of isolated left atrial appendage management who are not candidates for surgical ablation. The importance of a multidisciplinary team assessment, treatment planning, and long-term follow-up are reiterated in this clinical practice guideline with a class I recommendation, along with the other recommendations from the 2017 guidelines that remained unchanged in their class of recommendation and level of evidence.
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Affiliation(s)
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Panos N Vardas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thoralf M Sundt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Kiankhooy A, Pierce C, Burk S, Phillips A, Eisenberg S, Dunnington G. Hybrid ablation of persistent and long-standing persistent atrial fibrillation with depressed ejection fraction: A single-center observational study. JTCVS OPEN 2022; 12:137-146. [PMID: 36590727 PMCID: PMC9801285 DOI: 10.1016/j.xjon.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The relationship between atrial fibrillation (AF) and heart failure with depressed ejection fraction (EF) is complex. AF-related tachycardia-mediated cardiomyopathy (TMC) can lead to worsening EF and clinical heart failure. We sought to determine whether a hybrid team ablation approach (HA) can be performed safely and restore normal sinus rhythm in patients with TMC and heart failure and to delineate the effect on heart failure. METHODS We retrospectively analyzed patients with nonparoxysmal (ie, persistent and long-standing persistent) AF-related TMC with depressed left ventricular EF (LVEF ≤40%) and heart failure (New York Heart Association [NYHA] class ≥2) who underwent HA between 2013 and 2018 and had at least 1 year of follow-up. Pre-HA and post-HA echocardiograms were compared for LVEF and left atrial (LA) size. Rhythm success was defined as <30 seconds in AF/atrial flutter/atrial tachycardia without class I or III antiarrhythmic drugs. Results are expressed as mean ± SD and 95% confidence interval (CI) of the mean. RESULTS Forty patients met the criteria for inclusion in our analysis. The mean patient age was 67 ± 9.4 years. The majority of patients had long-standing persistent AF (26 of 40; 65%), and the remainder had persistent AF (14 of 40; 35%). All patients had NYHA class II or worse heart failure (NYHA class II, 36 of 40 [90%]; NYHA class III, 4 of 40 [10%]). The mean time in AF pre-HA was 5.6 ± 6.7 years. All patients received both HA stages. No deaths or strokes occurred within 30 days. Three new permanent pacemakers (7.5%) were placed. Rhythm success was achieved in >60% of patients during a mean 3.5 ± 1.9 years of follow-up. LVEF improved significantly by 12.0% ± 12.5% (95% CI, 7.85%-16.0%; P < .0001), and mean LA size decreased significantly by 0.40 cm ± 0.85 cm (95% CI, 0.69-0.12 cm; P < .01), with a mean of 3.0 ± 1.5 years between pre-HA and post-HA echocardiography. NYHA class improved significantly after HA (mean pre-HA NYHA class, 2.1 ± 0.3 [95% CI, 2.0-2.2]; mean post-HA NYHA class, 1.5 ± 0.6 [95% CI, 1.3-1.7]; P < .0001). CONCLUSIONS Thoracoscopic HA of AF in selected patients with TMC heart failure is safe and can result in rhythm success with structural heart changes, including improvements in LVEF and LA size.
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Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- AT, atrial tachycardia
- CA, catheter ablation
- HA, hybrid ablation
- LA, left atrium/atrial
- LVEF, left ventricular ejection fraction
- NYHA, New York Heart Association
- PV, pulmonary vein
- TMC, tachycardia-mediated cardiomyopathy
- arrythmia surgery
- heart failure
- hybrid ablation
- left ventricular ejection fraction
- tachycardia-mediated cardiomyopathy
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Affiliation(s)
- Armin Kiankhooy
- Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St Helena, Calif
| | - Carolyn Pierce
- Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St Helena, Calif
| | - Shelby Burk
- Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St Helena, Calif
| | - Andrew Phillips
- Virginia Commonwealth University School of Medicine, Richmond, Va
| | - Susan Eisenberg
- Department of Electrophysiology, Adventist Health-St Helena Hospital, St Helena, Calif
| | - Gansevoort Dunnington
- Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St Helena, Calif
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Usui R, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Inden Y, Murohara T, Usui A. Higher F-wave frequency associates with poor procedural success rate after Maze procedure. Gen Thorac Cardiovasc Surg 2022; 70:997-1004. [PMID: 35771344 DOI: 10.1007/s11748-022-01836-0] [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: 04/10/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure. METHODS In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002-2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program. RESULTS Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF (< 7.3 Hz) and higher voltage group (> 0.13 mV) showed a good rate (86%). CONCLUSIONS The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.
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Affiliation(s)
- Rena Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Wataru Uchida
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Kiankhooy A, McMenamy ME. The Convergent Procedure for AF: A Surgeon's Perspective. J Cardiovasc Electrophysiol 2022; 33:1919-1926. [PMID: 35132722 DOI: 10.1111/jce.15404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Abstract
The Converge IDE Trial demonstrated improved patient outcomes in a challenging persistent and long-standing persistent atrial fibrillation population using a heart team hybrid approach with epicardial and endocardial staged ablations. Surgeons encounter unique circumstances with the surgical epicardial stage of the Convergent procedure which include unfamiliarity with left atrial posterior anatomy, endoscopic/thoracoscopic visualization, minimally invasive left atrial appendage management and expanded indications for the procedure. Overcoming these unique challenges is key to the adoption of the Convergent procedure as a critical off-pump approach that should be part of the surgical armamentarium in the treatment of atrial fibrillation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Armin Kiankhooy
- 6 Woodland Road, Suite 304, St. Helena, CA 94574, Adventist Health - St. Helena
| | - Maureen E McMenamy
- UCSF Medical Center at Parnassus, Division of Adult Cardiothoracic Surgery, 505 Parnassus Ave, San Francisco, CA, 94143
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Song L, Fan C, Zhang H, Liu H, Iroegbu CD, Luo C, Liu L. Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia. Front Cardiovasc Med 2021; 8:722413. [PMID: 34595222 PMCID: PMC8476783 DOI: 10.3389/fcvm.2021.722413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
The safety and efficacy of the Cox-Maze IV procedure (CMP-IV) for situs inversus dextrocardia patients with atrial fibrillation is yet to be determined. Herein, we present the case of a 39-year-old male patient admitted to our cardiac center following progressive exertional dyspnea. The patient was diagnosed with situs inversus dextrocardia, severe mitral regurgitation, and paroxysmal atrial fibrillation. A three-dimensional (3D) heart model printing device embedded with designated ablation lines was used for pre-operative planning. Mitral valvuloplasty, CMP-IV, and tricuspid annuloplasty were performed. The patient had an uneventful recovery and was in sinus rhythm during a 12-month follow-up period using a 24-h Holter monitoring device. The case herein is one of the first to report on adopting the CMP-IV procedure for situs inversus dextrocardia patients with complex valvuloplasty operation. In addition, the 3D printing technique enabled us to practice the Cox-maze IV procedure, given the patient's unique cardiac anatomy.
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Affiliation(s)
- Long Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongduan Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chukwuemeka Daniel Iroegbu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Luo
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liming Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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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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Kakuta T, Fukushima S, Minami K, Saito T, Kawamoto N, Tadokoro N, Ikuta A, Kobayashi J, Fujita T. Novel risk score for predicting recurrence of atrial fibrillation after the Cryo-Maze procedure. Eur J Cardiothorac Surg 2021; 59:1218-1225. [PMID: 33550393 DOI: 10.1093/ejcts/ezaa468] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to develop a novel risk score model for quantitative prediction of the rate of atrial fibrillation (AF) recurrence after the Cryo-Maze procedure in patients with persistent AF. METHODS We enrolled 450 consecutive patients who underwent the Cryo-Maze procedure for persistent AF concomitant with other cardiac procedures in our institute between 2001 and 2019. We randomly divided the cohort into two groups. We derived a model in a 'development cohort' (270 patients; 60%) and validated it in a 'test cohort' (180 patients; 40%) by receiver operating characteristic curve analysis. RESULTS The median follow-up was 5.2 (interquartile range: 2.0-9.9) years. The 1-, 5-, 10- and 15-year rates of freedom from AF recurrence in the entire cohort were 91.4%, 83.5%, 76.2% and 57.1%, respectively. Risk factors for AF recurrence examined by logistic regression analysis included F-wave voltage in V1 < 0.2 mV, preoperative AF duration >5 years and left atrial volume index >100 ml/m2. Points were assigned to each risk factor according to its odds ratio. A novel risk score model was developed using these three variables and age, with a range up to 10 points. High score (>7) predicted high rates of AF recurrence after the Cryo-Maze procedure. The area under the receiver operating characteristic curve of the novel risk model score was 0.78 (95% confidence interval: 0.65-0.91) in the test cohort. CONCLUSIONS Use of the Cryo-Maze procedure should be carefully considered in patients with a higher model score because of a higher risk of AF recurrence.
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Affiliation(s)
- Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Ayumi Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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Yu HT, Kim IS, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Persistent atrial fibrillation over 3 years is associated with higher recurrence after catheter ablation. J Cardiovasc Electrophysiol 2020; 31:457-464. [PMID: 31919909 PMCID: PMC7027787 DOI: 10.1111/jce.14345] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023]
Abstract
Instruction Longer atrial fibrillation (AF) durations have higher recurrence rates after rhythm control. However, there is limited data on the effect of the AF duration on recurrence after atrial fibrillation catheter ablation (AFCA). In the present study, we investigated the rhythm outcome of AFCA according to the AF duration based on the first electrocardiogram (ECG) diagnosis. Methods and Results We included 1005 patients with AF (75% male, 59 ± 11 years old) who underwent AFCA and whose first ECG diagnosis time point was evident. The clinical characteristics and rhythm outcomes were compared based on the AF duration (≤3 years, n = 537; >3 years, n = 468) and AF burden (paroxysmal atrial fibrillation [PAF], n = 387; persistent atrial fibrillation [PeAF], n = 618). Longer AF durations were associated with older age (P = .020), larger left atrial size (P = .009) and a higher number of patients with hypertension (P < .001) or PeAF (P < .001). During 24 ± 22 months of follow‐up, the postablation clinical recurrence rate was higher in patients with a longer AF duration (logrank P = .002). The AF recurrence rate was significantly higher in PeAF patients with an AF duration >3 years (logrank P = 0.009), but not in subjects with PAF (logrank P = .939). In a multivariate Cox regression analysis, a longer AF duration was significantly associated with a higher clinical recurrence rate after AFCA in PeAF patients (adjusted hazard ratio, 1.06; range, 1.03‐0.10; P = 0.001), but not PAF. Conclusion Although longer AF duration was associated with higher clinical recurrence rates after AFCA, the rate was significant in patients with PeAF lasting >3 years, but not in PAF patients.
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Affiliation(s)
- Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Soo Kim
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong-Youn Kim
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
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Ad N. Decision-making in Surgical Treatment for Stand-alone Atrial Fibrillation: Minimally Invasive Cox Maze Procedure. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:487-492. [DOI: 10.1177/1556984519884534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niv Ad
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- White Oak Medical Center, Silver Spring, MD, USA
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Raissouni K, Petrosyan A, Malapert G, Jazayeri S, Morgant MC, Bouchot O. Concomitant Cardiac Surgery and Radiofrequency Ablation of Atrial Fibrillation: A Retrospective Single Center Study. J Cardiothorac Vasc Anesth 2019; 34:401-408. [PMID: 31629606 DOI: 10.1053/j.jvca.2019.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/14/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Concomitant cardiac surgery and radiofrequency atrial fibrillation (AF) ablation is an established procedure recommended in guidelines. However, the results have not been as good as expected. The authors therefore searched for predictive factors of success of the ablation procedure. DESIGN The authors carried out a retrospective cohort study. SETTING All the included patients had cardiac surgery in the Dijon University Hospital. PARTICIPANTS One hundred sixty-three patients with AF underwent a concomitant radiofrequency ablation between January 2009 and December 2016. INTERVENTIONS A radiofrequency device was used to isolate the pulmonary veins creating a "Box lesion." MEASUREMENTS AND MAIN RESULTS The primary endpoint of the study was freedom from AF at 12 months with follow-up assessed by an electrocardiogram or a 24-hour recording electrocardiogram Holter. The patient's mean age was 71 ± 9 years with a sex ratio of 1.4. Sixty-six percent of patients had paroxysmal AF and 34% nonparoxysmal AF, which includes persistent and long-standing persistent AF. Sixty-one percent of patients had an AF history for more than 1 year. The mean left atrial diameter was 47 ± 10 mm. No major ablation complications related to the procedure occurred. Overall freedom from AF rate after 1-year follow-up was 60% (n = 98). Six patients (4%) received an additional catheter-based ablation, and 10 patients (6%) had an electrical cardioversion during the follow-up period. The authors identified preoperative paroxysmal AF (odds ratio [OR] 2.54 [1.27-5.14] p = 0.008) and recent history of AF, less than 1 year, (OR 1.99 [1-4.06] p = 0.05) as statistically significant predictors for sinus rhythm maintenance at the 12-month follow-up. At the 12-month follow-up, 64% of patients who had concomitant epicardial treatment were in sinus rhythm and 57% of patients were in sinus rhythm after endocardial treatment. There were no significant differences in rhythm outcome between epicardial and endocardial radiofrequency approach, or between surgical procedures (mitral valve replacement versus coronary artery bypass grafting). The authors could not identify in a univariate analysis a significant left atrium size cutoff upon which ablation was less likely to be successful at 12 months follow-up. CONCLUSIONS Concomitant cardiac surgery and radiofrequency AF ablation provided freedom from AF for 60% of patients after 1-year follow-up. The authors have shown that paroxysmal AF and recent AF are predictive factors of success. Nevertheless, thorough postoperative care is necessary to improve long-term results, including the use of additional catheter ablation or cardioversion.
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The long-term safety and efficacy of concomitant Cox maze procedures for atrial fibrillation in patients without mitral valve disease. J Thorac Cardiovasc Surg 2019; 157:1505-1514. [DOI: 10.1016/j.jtcvs.2018.09.131] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
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Elbadawi A, Elgendy IY, Mahmoud AH, Ogunbayo GO, Saad M, Megaly M, Alotaki E, Mentias A, Barakat AF, London B. Outcomes of Surgical Ablation in Patients With Atrial Fibrillation Undergoing Cardiac Surgeries. Ann Thorac Surg 2018; 107:1395-1400. [PMID: 30481521 DOI: 10.1016/j.athoracsur.2018.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/18/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surgical ablation procedure is commonly performed in patients with atrial fibrillation (AF) undergoing cardiac surgeries; however, the evidence regarding its impact on in-hospital cardiovascular outcomes is controversial. METHODS We queried the Nationwide Inpatient Sample Database for patients with AF who underwent cardiac surgeries from 1998 to 2013. We performed a propensity-score matching including 21 various baseline characteristics to compare those who underwent surgical ablation with those who had not. RESULTS A total of 47,964 hospitalizations were included in our final analysis. On propensity matching, 23,975 were in the surgical ablation group and 23,990 in the control group. The primary outcome of in-hospital mortality was lower in the surgical ablation group compared with the control group (3.6% versus 4.2%, p < 0.001). The surgical ablation group was associated with lower in-hospital cerebrovascular accident (2.0% versus 2.8%, p < 0.001), cardiogenic shock (2.6% versus 3.6%, p < 0.001), use of intraaortic balloon pump (5.1% versus 5.8%, p = 0.001), and shorter length of hospital stay (12.3 ± 10.1 versus 12.5 ± 10.3 days, p = 0.008). There was no difference between the surgical ablation and control groups in the incidence of cardiac tamponade (0.4% versus 0.3%, p = 0.296). The surgical ablation group was associated with a higher rate of complete heart block (5.2% versus 4.3%, p < 0.001) and permanent pacemaker insertion (8.6% versus 8.0%, p = 0.01). CONCLUSIONS In this large analysis of almost 50,000 patients with AF undergoing cardiac surgery, surgical ablation appears to be safe in the short term. Future studies should focus on evaluating the long-term effectiveness of this procedure.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Ahmed H Mahmoud
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Marwan Saad
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michael Megaly
- Minneapolis Heart Institute at Abbot Northwestern Hospital, Minneapolis, Minnesota
| | - Erfan Alotaki
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amgad Mentias
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Amr F Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barry London
- Department of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
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Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, McCarthy PM, Thourani VH, Suri RM, Jacobs JP, Cox JL. Surgical Ablation of Atrial Fibrillation in the United States: Trends and Propensity Matched Outcomes. Ann Thorac Surg 2017; 104:493-500. [DOI: 10.1016/j.athoracsur.2017.05.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/02/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2017; 103:329-341. [PMID: 28007240 DOI: 10.1016/j.athoracsur.2016.10.076] [Citation(s) in RCA: 336] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
Abstract
EXECUTIVE SUMMARY Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion).
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