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Zheng Z, Yao Y, Li H, Yu C, Zheng L, Ding L, Wu L, Chen S, Lin H, Meng Y. Comparing simultaneous hybrid ablation with stand-alone thoracoscopic surgical ablation for the treatment of non-paroxysmal atrial fibrillation: a prospective randomized controlled trial. Europace 2024; 26:euae226. [PMID: 39226147 PMCID: PMC11411208 DOI: 10.1093/europace/euae226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/14/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024] Open
Abstract
AIMS Advanced atrial fibrillation (AF) is currently a dilemma for electrophysiologists when choosing a minimally invasive treatment strategy. Previous studies have demonstrated the outcome of either catheter ablation or thoracoscopic surgical ablation (SA) is unsatisfactory in these patients. Whether hybrid ablation (HA) could improve outcomes in these patients is unknown. The purpose of this study was to evaluate the clinical efficacy of HA for the treatment of advanced AF. METHODS AND RESULTS A randomized controlled trial was designed to enrol patients with persistent AF (PerAF) and enlarged left atrium or long-standing persistent AF (LSPAF) who were randomized to HA or thoracoscopic SA at a 1:1 ratio. The primary endpoint was freedom from any recurrence of AF off antiarrhythmic drugs (AADs) 12 months after operation. The primary endpoint was monitored by 7-day electrocardiogram monitoring devices. One hundred patients were enrolled. The mean age was 58.5 ± 7.6 years, and the mean left atrial diameter (LAD) was 50.1 ± 6.1 mm. At 12 months, freedom from AF off AADs was recorded in 71.4% (35/49) of patients in HA group and 45.8% (22/48) in SA group [odds ratio 2.955, 95% confidence interval (1.275-6.848), P = 0.014]. HA significantly reduced patients' AF burden (30.2% in SA group and 14.8% in HA group, P = 0.048) and the LAD (mean differences: -5.53 ± 4.97 mm in HA group and -3.27 ± 5.20 mm in SA group, P = 0.037) at 12 months after operation. CONCLUSION In patients with PerAF and enlarged left atrium or LSPAF, HA achieved better freedom from AF after 1 year of follow-up compared with thoracoscopic SA.
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Affiliation(s)
- Zhe Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Haojie Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Chunyu Yu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Lihui Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Ligang Ding
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Lingmin Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Sipeng Chen
- Department of Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, People’s Republic of China
| | - Hengqiang Lin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
| | - Ying Meng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing 100037, People’s Republic of China
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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] [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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Eranki A, Wilson-Smith A, Flynn C, Williams M, Manganas C. Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis. J Cardiothorac Surg 2023; 18:155. [PMID: 37076929 PMCID: PMC10114378 DOI: 10.1186/s13019-023-02189-2] [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: 09/09/2022] [Accepted: 03/21/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Atrial Fibrillation (AF) is a common tachyarrhythmia affecting 33 million people worldwide. Hybrid AF ablation utilises a surgical (epicardial) ablation followed by an endocardial catheter-based ablation. The aim of this systematic review and meta-analysis is to summarize the literature reporting mid-term freedom from AF following hybrid ablation. METHODS An electronic search of databases was performed to identify all relevant studies providing mid-term (2 year) outcomes following hybrid ablation for AF. The primary study outcome was to assess the mid-term freedom from AF following hybrid ablation, utilising the metaprop function on Stata® (Version 17.0, StataCorp, Texas, USA). Subgroup analysis was performed to assess the impact of various operative characteristics on mid-term freedom from AF. The secondary outcomes assessed mortality and procedural complication rate. RESULTS The search strategy identified 16 studies qualifying for inclusion in this meta-analysis, with 1242 patients in total. The majority of papers were retrospective cohort studies (15) and one study was a randomized control trial (RCT). The mean follow up was 31.5 ± 8.4 months. Following hybrid ablation, the overall mid-term freedom from AF was 74.6% and 65.4% for patients off antiarrhythmic drugs (AAD). Actuarial freedom from AF was 78.2%, 74.2% and 73.6% at 1, 2 and 3 years respectively. No significant differences in mid-term freedom from AF based epicardial lesion set (box vs pulmonary vein isolation) or Left atrial appendage/Ganglionated Plexus/Ligament of Marshall ablation or staged vs concomitant procedures. There were 12 deaths overall following the hybrid procedure with a pooled complication rate of 5.53%. CONCLUSION Hybrid AF ablation offers promising mid-term freedom from AF reported at a mean follow-up of 31.5 months. The overall complication rate remains low. Further analysis of high-quality studies with randomized data and long-term follow up will help verify these results.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, St. George Hospital, Kograh, Sydney, 2217, Australia.
| | - Ashley Wilson-Smith
- The Chris O'Brien Lifehouse Center, Sydney, Australia
- The Collaborative Research Group (CORE), Sydney, Australia
- The University of Sydney, Sydney, Australia
- The John Hunter Hospital, Newcastle, Australia
| | - Campbell Flynn
- Department of Cardiothoracic Surgery, St. George Hospital, Kograh, Sydney, 2217, Australia
| | - Michael Williams
- Department of Cardiothoracic Surgery, Dunedin Hospital, Great King Street, Dunedin Otago, New Zealand
| | - Con Manganas
- Department of Cardiothoracic Surgery, St. George Hospital, Kograh, Sydney, 2217, Australia
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Mannakkara NN, Porter B, Child N, Sidhu BS, Mehta VS, Elliott MK, Gould J, Ahmed S, Razavi R, Rinaldi CA, Blauth C, Gill JS. Convergent ablation for persistent atrial fibrillation: outcomes from a single-centre real-world experience. Eur J Cardiothorac Surg 2022; 63:6809126. [PMID: 36346176 PMCID: PMC9748999 DOI: 10.1093/ejcts/ezac515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/09/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Atrial fibrillation (AF) is common and can cause significant morbidity and detriment to quality of life. Success rates for conventional catheter ablation are suboptimal in persistent AF (PsAF), especially when longstanding. Convergent hybrid ablation combines endoscopic surgical epicardial and endocardial catheter ablation. It offers promise in treating PsAF. We aimed to evaluate outcomes at our centre following convergent ablation. METHODS We conducted an observational study of patients undergoing ablation from 2012 to 2019 at a London cardiac centre. Sixty-seven patients underwent convergent ablation entailing epicardial ablation, mostly via sub-xiphoid access, followed by endocardial left atrial catheter ablation. Baseline and follow-up data were obtained retrospectively from clinical records. Primary outcome was freedom from AF on/off anti-arrhythmic drugs after 12-month follow-up. Secondary outcomes included freedom from AF over the entire follow-up, freedom from anti-arrhythmic drugs, freedom from atrial arrhythmias, symptom status, repeat ablation and complications. RESULTS At baseline, 80.6% had PsAF >1 year (80.6%), 49.3% had body mass index >30 kg/m2 at baseline and 19.4% had left ventricular ejection fraction of 40% or less. The median follow-up was 2.3 (1.4-3.7) years. Freedom from AF recurrence was 81.3% at 1 year and 61.5% over overall follow-up. Eleven patients (16.4%) required redo AF ablation. Prolonged AF duration was associated with increased recurrence at 12 months and duration >5 years with a shorter time to recurrence on Kaplan-Meier analysis, but this and other factors did not significantly impact the AF recurrence during the overall follow-up period. CONCLUSIONS Convergent ablation had good 1-year and overall success rates for treating PsAF. Our results in a diverse, real-world population support the potential of convergent ablation in patients with challenging to treat PsAF.
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Affiliation(s)
- Nilanka N Mannakkara
- Corresponding author. Department of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor North Wing, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK. Tel: +44-20-7836-5454; e-mail: (N.N. Mannakkara)
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Nicholas Child
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Vishal S Mehta
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Mark K Elliott
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Justin Gould
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Shahada Ahmed
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Christopher A Rinaldi
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Christopher Blauth
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK
| | - Jaswinder S Gill
- Department of Cardiovascular Services, Guy’s and St. Thomas’ Hospital, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
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Ranjan R, Kaba R, Chandrasekaran V, Momin A. The Convergent Ablation and AtriClip Exclusion of the Left Atrial Appendage in Long-Standing Persistent Atrial Fibrillation. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221120778. [PMID: 36046371 PMCID: PMC9421220 DOI: 10.1177/11795476221120778] [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: 03/09/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
We here present a case of a 54-year-old man with longstanding persistent
atrial fibrillation refractory to direct current electrical
cardioversion who underwent a concurrent convergent ablation and
Atriclip exclusion of left atrial appendage. His preoperative
echocardiography revealed dilated 5.8 cm left atrium with a normal
left ventricular ejection fraction of 50%. Transmural isolation of
pulmonary veins was performed through a subxiphoid approach, and 3
left-sided video-assisted thoracoscopic surgery ports were utilised to
occlude the base of the left atrium appendage with the Atriclip
device. A peri-operative transoesophageal echocardiogram confirmed
left atrium appendage base occlusion, and the patient was in sinus
rhythm after having a single 200 kJ direct current cardioversion
shock. The postoperative period was uneventful, and the patient was
discharged with preprocedural anticoagulant after 24 hours of the
procedure and advised to come for follow up after 3 months.
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Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Riyaz Kaba
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Aziz Momin
- St. George's University Hospitals NHS Foundation Trust, London, UK
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Hao J, Xi Y, Chen W, Liang Y, Lin Z, Wei W. Hybrid ablation procedure for the treatment of nonparoxysmal atrial fibrillation: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2022; 45:1132-1140. [PMID: 35616829 DOI: 10.1111/pace.14539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hybrid ablation combines the advantages of surgical and catheter ablation. Many studies have explored the efficiency and safety of hybrid ablation in patients with nonparoxysmal AF. METHODS We systematically searched for prospective controlled trials that compared hybrid ablation with catheter/surgical ablation in PubMed, Web of Science, Wiley Library and CNKI. Our main assessment indicators included maintenance of sinus rhythm without antiarrhythmic drugs for more than 12 months, major adverse events (MAEs), procedure time and fluoroscopy time. RESULTS Of 1214 identified studies, 5 were eligible and were included in our analysis (N = 451 participants). The pooled results showed that hybrid ablation was more effective in maintaining SR than a single procedure (surgical ablation or catheter ablation) (OR = 2.52, 95% confidence interval [CI]: 1.63-3.89, P<0.001). Little significant heterogeneity was revealed (P = 0.32 for heterogeneity, I2 = 14%). More MAEs occurred in the hybrid group than in the single procedure group (OR = 7.47, 95% CI: 1.90-29.41, P = 0.004; I2 = 0%). Two trials reported the procedure and fluoroscopy times, and the procedure time for hybrid ablation was significantly longer than that of a single procedure (mean difference = 107.42, 95% CI: 88.62 to 126.22, P < 0.001; I2 = 82%). There was no significant difference in fluoroscopy time between the 2 groups (mean difference = -1.00, 95% CI: -5.37 to 3.36, P = 0.65; I2 = 12%). CONCLUSIONS Hybrid ablation was more effective than catheter ablation and was as effective as surgical ablation in patients with nonparoxysmal AF. Meanwhile, hybrid ablation, especially concomitant hybrid ablation, increases the incidence of MAEs and prolongs the procedure time. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Junhai Hao
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yue Xi
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wanwen Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuanfeng Liang
- Institute of Geriatric medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Zhanyi Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Institute of Geriatric medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Pešl M, Kulík T, Ostřížek T, Horváth V, Souček F, Melajová K, Doležalová K, Žáková D, Jadczyk T, Lehar F, Jež J, Stárek Z. Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation. VNITRNI LEKARSTVI 2022; 68:20-26. [PMID: 36283813 DOI: 10.36290/vnl.2022.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center. Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly dilated left atrium 57.9 ± 11.0mm in the period September 2016-March 2019. RESULTS The median duration of the procedure was 232 minutes and the median duration of hospitalization was 10 days. At discharge, 52 patients (100%) had sinus rhythm. 48 of 52 patients (92.3%) had a 6-month follow-up. 41 of 48 (85.4%) and 38 of 44 (86.4%) of patients were AF free at 3-month and 6-month follow-up, respectively. Acute complications were: one left atrial perforation resolved successfully by suture and one transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae. CONCLUSION Hybrid thoracoscopic-catheter ablation performed during one procedure is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation.
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Santhakumaran S, Salimi A, Brunetti V, Galic J. Efficacy and safety of aflibercept therapy for diabetic macular edema: A systematic review and meta-analysis. J Curr Ophthalmol 2022; 34:133-147. [PMID: 36147265 PMCID: PMC9486998 DOI: 10.4103/joco.joco_308_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: To assess the real-world efficacy and safety of aflibercept for the treatment of diabetic macular edema (DME). Methods: A systematic search was conducted across multiple databases. Articles were included if participants had DME and received aflibercept treatment for a minimum of 52 ± 4 weeks. Primary outcomes included changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A risk of bias assessment of studies was completed, pooled estimates were obtained, and a meta-regression was performed. Information on adverse events was collected. Results: The search yielded 2112 articles, of which 30 were included. Aflibercept was more effective than laser photocoagulation functionally (12-month BCVA-weighted mean difference [WMD] = 10.77 letters, P < 0.001; 24 months = 8.12 letters, P < 0.001) and anatomically (12-month CMT WMD = –114.12 μm, P < 0.001; 24 months = –90.4 μm, P = 0.004). Compared to bevacizumab, aflibercept was noninferior at improving BCVA at 12 months (WMD = 1.71 letters, P = 0.34) and 24 months (WMD = 1.58 letters, P = 0.083). One study found that aflibercept was more effective than bevacizumab anatomically at 1 and 2 years (P < 0.001 at 12 and 24 months). Compared to ranibizumab, aflibercept rendered a greater improvement in BCVA at 1 year (WMD = 1.76 letters, P = 0.001), but not 2 years (WMD = 1.66 letters, P = 0.072). CMT was not significantly different between both therapies at 12 months (WMD = −14.30 μm, P = 0.282) and 24 months (P = 0.08). One study reported greater functional improvement with aflibercept compared with dexamethasone (P = 0.004), but inferiority in reducing CMT (P < 0.001). Meta-regression analysis demonstrated that dosing schedule was found to impact outcomes at 12 and 24 months, while study design and sample size did not impact outcomes at 12 months. There were minimal safety concerns using aflibercept therapy. Conclusions: Aflibercept is a safe and effective therapy option for DME in the clinical setting, performing superiorly to laser photocoagulation. Evidence regarding comparisons with bevacizumab, ranibizumab, and dexamethasone is mixed and limited.
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Yammine M, Puskas J, El Moheb M, Lattouf O. The surgical technique of the convergent procedure. J Cardiovasc Electrophysiol 2021; 32:3221-3227. [PMID: 34559431 DOI: 10.1111/jce.15252] [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: 01/01/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
The convergent procedure is a newly developed hybrid ablation procedure that involves extensive epicardial ablation of the posterior left atrial wall followed by endocardial mapping and addition of pulmonary vein isolation. It is a team-based approach that provides a promising option for patients with persistent and permanent atrial fibrillation. In this manuscript, we present a detailed description of the surgical component of this procedure and include potential pitfalls based on our experience in performing it.
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Affiliation(s)
- Maroun Yammine
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York City, New York, USA
| | - Mohamad El Moheb
- Department of Surgery, Emory University Hospital, Atlanta, Georgia, USA
| | - Omar Lattouf
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York City, New York, USA.,Department of Surgery, Emory University Hospital, Atlanta, Georgia, USA
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10
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Yi S, Liu X, Wang W, Chen L, Yuan H. Thoracoscopic surgical ablation or catheter ablation for patients with atrial fibrillation? A systematic review and meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg 2020; 31:763-773. [PMID: 33166993 DOI: 10.1093/icvts/ivaa203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Shaolei Yi
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Xiaojun Liu
- Department of Cardiology, Zibo Central, Zibo, China
| | - Wei Wang
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Lianghua Chen
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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11
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Zheng Z, Yao Y, Li H, Zheng L, Liu S, Lin H, Duan F. Simultaneous hybrid maze procedure for long-standing persistent atrial fibrillation with dilated atrium. JTCVS Tech 2020; 5:34-42. [PMID: 34318103 PMCID: PMC8300042 DOI: 10.1016/j.xjtc.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background The efficacy of catheter-based or thoracoscopic ablation for treating long-standing persistent atrial fibrillation (AF) with a dilated atrium remains suboptimal. This study aimed to assess the feasibility and initial results of simultaneous hybrid ablation with a new biatrial lesion set in these patients. Methods Twenty-seven consecutive patients with long-standing persistent AF and dilated atrium underwent simultaneous hybrid ablation with a new biatrial lesion set consistent with the principle of the Cox maze procedure at our institution. Patients were followed up at 3, 6, and 12 months after the procedure and annually thereafter. Results After thoracoscopic epicardial ablation, endocardial mapping confirmed complete bilateral pulmonary vein isolation in 25 patients (96.2%). All patients were followed for a mean of 18.7 ± 8.9 months. Freedom from atrial tachyarrhythmia at 1 year after the single hybrid procedure was 64% with antiarrhythmic drugs and 60% without antiarrhythmic drugs. Freedom from atrial tachyarrhythmia at latest follow-up after the hybrid procedure and redo catheter ablation was 77.8% with antiarrhythmic drugs and 74.1% without antiarrhythmic drugs. In patients with sinus rhythm restoration, mean left atrial diameter decreased from 54.4 ± 4.3 mm to 45.2 ± 4.1 mm (P < .001), and mean right atrial diameter decreased from 59.4 ± 3.9 mm to 54.9 ± 4.4 mm (P < .001). Postoperative pleural effusion was observed in 3 patients (11.1%), and no adverse events occurred during follow-up. Conclusions In patients with long-standing persistent AF and a dilated atrium, simultaneous hybrid ablation with the new biatrial lesion set, in combination with touch-up catheter ablation when necessary, can achieve promising results. More studies are needed to confirm these findings.
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Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- CA, catheter ablation
- ECG, electrocardiography
- IVC, inferior vena cava
- LA, left atrium
- LAA, left atrial appendage
- LAD, left atrial diameter
- LSPAF, long-standing persistent atrial fibrillation
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- PV, pulmonary vein
- RA, right atrium
- RAD, right atrial diameter
- SR, sinus rhythm
- SVC, superior vena cava
- dilated atrium
- hybrid ablation
- long-standing persistent atrial fibrillation
- maze
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Affiliation(s)
- Zhe Zheng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Yao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Liu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengqiang Lin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fujian Duan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Medical Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Chen JM, Zhong YT, Tu C, Lan J. Significance of serum fibroblast growth factor-23 and miR-208b in pathogenesis of atrial fibrillation and their relationship with prognosis. World J Clin Cases 2020; 8:3458-3464. [PMID: 32913852 PMCID: PMC7457118 DOI: 10.12998/wjcc.v8.i16.3458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence and prevalence of atrial fibrillation are increasing each year, and this condition is one of the most common clinical arrhythmias.
AIM To investigate the levels and significance of serum fibroblast growth factor 23 (FGF-23) and miR-208b in patients with atrial fibrillation and their relationship with prognosis.
METHODS From May 2018 to October 2019, 240 patients with atrial fibrillation were selected as an observation group, including 134 with paroxysmal atrial fibrillation and 106 with persistent atrial fibrillation; 150 patients with healthy sinus rhythm were selected as a control group. The serum levels of FGF-23 and miR-208b in the two groups were measured. In the observation group, cardiac parameters were determined by echocardiography.
RESULTS The serum levels of FGF-23 and miR-208b in the observation group were 210.20 ± 89.60 ng/mL and 5.30 ± 1.22 ng/mL, which were significantly higher than the corresponding values in the control group (P < 0.05). In the observation group, the serum levels of FGF-23 and miR-208b in patients with persistent atrial fibrillation were 234.22 ± 70.05 ng/mL and 5.83 ± 1.00 ng/mL, which were significantly higher than the corresponding values in patients with paroxysmal atrial fibrillation (P < 0.05). The left atrial dimension (LAD) of patients with persistent atrial fibrillation was 38.81 ± 5.11 mm, which was significantly higher than that of patients with paroxysmal atrial fibrillation (P > 0.05). The serum levels of FGF-23 and miR-208b were positively correlated with the LAD (r = 0.411 and 0.382, P < 0.05). In the observation group, the serum levels of FGF-23 and miR-208b in patients with a major cardiovascular event (MACE) were 243.30 ± 72.29 ng/mL and 6.12 ± 1.12 ng/mL, which were significantly higher than the corresponding values in patients without a MACE (P < 0.05).
CONCLUSION The serum levels of FGF-23 and miR-208b are increased in patients with atrial fibrillation and are related to the type of disease, cardiac parameters, and prognosis.
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Affiliation(s)
- Jie-Min Chen
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Yao-Tang Zhong
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Chang Tu
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
| | - Jun Lan
- Department of Cardiovascular Medicine, Dongguan Songshan Lake Central Hospital, Dongguan Institute of Cardiovascular Disease, Dongguan 523326, Guangdong Province, China
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13
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Wijesuriya N, Papageorgiou N, Maclean E, Saberwal B, Ahsan S. The Role of the Electrophysiologist in Convergent Ablation. Arrhythm Electrophysiol Rev 2020; 9:8-14. [PMID: 32637114 PMCID: PMC7330726 DOI: 10.15420/aer.2019.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.
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Affiliation(s)
| | | | - Edd Maclean
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Bunny Saberwal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Syed Ahsan
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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14
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Maclean E, Yap J, Saberwal B, Kolvekar S, Lim W, Wijesuriya N, Papageorgiou N, Dhillon G, Hunter R, Lowe M, Lambiase P, Chow A, Abbas H, Schilling R, Rowland E, Ahsan S. The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single centre, propensity-matched cohort study. Int J Cardiol 2020; 303:49-53. [DOI: 10.1016/j.ijcard.2019.10.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
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15
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Shah RL, Zaman JAB, Narayan SM. Catheter ablation or surgery to eliminate longstanding persistent atrial fibrillation. Int J Cardiol 2019; 303:54-55. [PMID: 31924396 DOI: 10.1016/j.ijcard.2019.12.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Rajan L Shah
- Department of Medicine, Stanford University, Stanford, USA
| | | | - Sanjiv M Narayan
- Department of Medicine, Stanford University, Stanford, USA; Cardiovascular Institute, Stanford University, Stanford, USA.
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16
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Hassan SM, Hong K, Rosati F, Glover B, Redfearn D, Enriquez A, Bisleri G. Hybrid ablation for atrial fibrillation: the importance of achieving transmurality and lesion validation. Minerva Cardioangiol 2019; 67:115-120. [DOI: 10.23736/s0026-4725.19.04918-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Salvador-Oliván JA, Marco-Cuenca G, Arquero-Avilés R. Errors in search strategies used in systematic reviews and their effects on information retrieval. J Med Libr Assoc 2019; 107:210-221. [PMID: 31019390 PMCID: PMC6466507 DOI: 10.5195/jmla.2019.567] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/01/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Errors in search strategies negatively affect the quality and validity of systematic reviews. The primary objective of this study was to evaluate searches performed in MEDLINE/PubMed to identify errors and determine their effects on information retrieval. METHODS A PubMed search was conducted using the systematic review filter to identify articles that were published in January of 2018. Systematic reviews or meta-analyses were selected from a systematic search for literature containing reproducible and explicit search strategies in MEDLINE/PubMed. Data were extracted from these studies related to ten types of errors and to the terms and phrases search modes. RESULTS The study included 137 systematic reviews in which the number of search strategies containing some type of error was very high (92.7%). Errors that affected recall were the most frequent (78.1%), and the most common search errors involved missing terms in both natural language and controlled language and those related to Medical Subject Headings (MeSH) search terms and the non-retrieval of their more specific terms. CONCLUSIONS To improve the quality of searches and avoid errors, it is essential to plan the search strategy carefully, which includes consulting the MeSH database to identify the concepts and choose all appropriate terms, both descriptors and synonyms, and combining search techniques in the free-text and controlled-language fields, truncating the terms appropriately to retrieve all their variants.
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Affiliation(s)
- José Antonio Salvador-Oliván
- Professor, Department of Library and Information Science and Faculty of Medicine, University of Zaragoza, Zaragoza, Spain,
| | - Gonzalo Marco-Cuenca
- Professor, Department of Library and Information Science and Faculty of Medicine, University of Zaragoza, Zaragoza, Spain,
| | - Rosario Arquero-Avilés
- Professor, Department of Library and Information Science, Complutense University of Madrid, Madrid, Spain,
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18
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Lee JM, Jeong DS, Yu HT, Park HS, Shim J, Kim JY, Kim J, Yoon NS, Oh S, Roh SY, Cho YJ, Kim KH. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part III. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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