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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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Veenhuyzen G, Mitchell LB. Selecting Persistent Atrial Fibrillation Patients for Adjunctive Right Atrial Ablation: When You're Right, You're Right. Can J Cardiol 2024; 40:573-575. [PMID: 38145869 DOI: 10.1016/j.cjca.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- George Veenhuyzen
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Foothills Hospital, Calgary, Alberta, Canada
| | - L Brent Mitchell
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Foothills Hospital, Calgary, Alberta, Canada.
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Hanafy DA, Erdianto WP, Husen TF, Nathania I, Vidya AP, Angelica R, Suwatri WT, Lintangella P, Prasetyo P, Sugisman. Three Ablation Techniques for Atrial Fibrillation during Concomitant Cardiac Surgery: A Systematic Review and Network Meta-Analysis. J Clin Med 2023; 12:5716. [PMID: 37685784 PMCID: PMC10488688 DOI: 10.3390/jcm12175716] [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: 07/06/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Atrial fibrillation (AF) ablation is a frequent procedure used in concomitant cardiac surgery. However, uncertainty still exists concerning the optimal extent of lesion sets. Hence, the objective of this study was to assess the results of various ablation techniques, aiming to offer a reference for clinical decision making. This review is listed in the prospective register of systematic reviews (PROSPERO) under ID CRD42023412785. A comprehensive search was conducted across eight databases (Scopus, Google Scholar, EBSCOHost, PubMed, Medline, Wiley, ProQuest, and Embase) up to 18 April 2023. Studies were critically appraised using the Cochrane Risk of Bias 2.0 for randomized control trials (RCTs) and the Newcastle Ottawa Scale adapted by the Agency for Healthcare Research and Quality (AHRQ) for cohort studies. Forest plots of pooled effect estimates and surface under the cumulative ranking (SUCRA) were used for the analysis. Our analysis included 39 studies and a total of 7207 patients. Both bi-atrial ablation (BAA) and left atrial ablation (LAA) showed similar efficacy in restoring sinus rhythm (SR; BAA (77.9%) > LAA (76.2%) > pulmonary vein isolation (PVI; 66.5%); LAA: OR = 1.08 (CI 0.94-1.23); PVI: OR = 1.36 (CI 1.08-1.70)). However, BAA had higher pacemaker implantation (LAA: OR = 0.51 (CI 0.37-0.71); PVI: OR = 0.52 (CI 0.31-0.86)) and reoperation rates (LAA: OR = 0.71 (CI 0.28-1.45); PVI: OR = 0.31 (CI 0.1-0.64)). PVI had the lowest efficacy in restoring SR and a similar complication rate to LAA, but had the shortest procedure time (Cross-clamp (Xc): PVI (93.38) > LAA (37.36) > BAA (13.89)); Cardiopulmonary bypass (CPB): PVI (93.93) > LAA (56.04) > BAA (0.03)). We suggest that LAA is the best surgical technique for AF ablation due to its comparable effectiveness in restoring SR, its lower rate of pacemaker requirement, and its lower reoperation rate compared to BAA. Furthermore, LAA ranks as the second-fastest procedure after PVI, with a similar CPB time.
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Affiliation(s)
- Dudy Arman Hanafy
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Kenari, Jakarta 10430, Indonesia; (D.A.H.)
- Division of Adult Cardiac Surgery, Department of Surgery, National Cardiovascular Center, Harapan Kita, Jakarta 11420, Indonesia;
| | - Wahyu Prima Erdianto
- Division of Adult Cardiac Surgery, Department of Surgery, National Cardiovascular Center, Harapan Kita, Jakarta 11420, Indonesia;
| | - Theresia Feline Husen
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok 16424, Indonesia
| | - Ilona Nathania
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok 16424, Indonesia
| | - Ananda Pipphali Vidya
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok 16424, Indonesia
| | - Ruth Angelica
- Faculty of Medicine, University of Indonesia, Pondok Cina, Beji, Depok 16424, Indonesia
| | - Widya Trianita Suwatri
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Kenari, Jakarta 10430, Indonesia; (D.A.H.)
- Division of Adult Cardiac Surgery, Department of Surgery, National Cardiovascular Center, Harapan Kita, Jakarta 11420, Indonesia;
| | - Pasati Lintangella
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Kenari, Jakarta 10430, Indonesia; (D.A.H.)
| | - Priscillia Prasetyo
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Kenari, Jakarta 10430, Indonesia; (D.A.H.)
| | - Sugisman
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Kenari, Jakarta 10430, Indonesia; (D.A.H.)
- Division of Adult Cardiac Surgery, Department of Surgery, National Cardiovascular Center, Harapan Kita, Jakarta 11420, Indonesia;
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