Recovery of Left Atrial Contractile Function After Maze Surgery in Persistent Longstanding Atrial Fibrillation

Abu‐Omar, Yasir; Thorpe, Benjamin; Freeman, Carol; Mills, Christine; Stoneman, Victoria; Gopalan, Deepa; Rana, Bushra S.; Spyt, Tomasz; Sharples, Linda D.; Nashef, Samer A.M.

doi:10.1016/j.jacc.2017.08.073

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…Similar results were found in the HESTER (Has Electrical Sinus Translated into Effective Remodelling?) study [35]: in this experience, adjunct surgical maze was associated with the recovery of LA function but with a mean active LA ejection fraction (ALAEF) lower in maze patients than in control subjects. Providing evidence that function is restored after adjunct maze, potential clinical benefits in reducing thromboembolic and heart failure risk will arise.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

Anselmino

Rovera²,

Marchetto

et al. 2019

Medicina

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Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

Anselmino

Rovera²,

Marchetto

et al. 2019

Medicina

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“…We found no impact in QoL at 2 years, but this is relatively short follow-up, and cardiac surgery alone achieves such an increase in QoL [ 19 ] that it may be difficult to discern additional benefits from AF surgery at this stage. Two factors may modify this conclusion in future: there was significantly less anticoagulation in ablation patients postoperatively with no increase in stroke rate, and the HESTER study [ 20 ] showed LA contractile recovery in most but not all patients when ablation restores SR. These results lend support to anticoagulation withdrawal when SR is restored after AF surgery, but the varying extent of the LA contractile recovery suggests that the LA function should be measured before contemplating withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Amaze: a randomized controlled trial of adjunct surgery for atrial fibrillation†

Nashef

Fynn

Abu‐Omar

et al. 2018

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESAtrial fibrillation (AF) reduces survival and quality of life (QoL). It can be treated at the time of major cardiac surgery using ablation procedures ranging from simple pulmonary vein isolation to a full maze procedure. The aim of this study is to evaluate the impact of adjunct AF surgery as currently performed on sinus rhythm (SR) restoration, survival, QoL and cost-effectiveness.METHODSIn a multicentre, Phase III, pragmatic, double-blinded, parallel-armed randomized controlled trial, 352 cardiac surgery patients with >3 months of documented AF were randomized to surgery with or without adjunct maze or similar AF ablation between 2009 and 2014. Primary outcomes were SR restoration at 1 year and quality-adjusted life years at 2 years. Secondary outcomes included SR at 2 years, overall and stroke-free survival, medication, QoL, cost-effectiveness and safety.RESULTSMore ablation patients were in SR at 1 year [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.20–3.54; P = 0.009]. At 2 years, the OR increased to 3.24 (95% CI 1.76–5.96). Quality-adjusted life years were similar at 2 years (ablation − control −0.025, P = 0.6319). Significantly fewer ablation patients were anticoagulated from 6 months postoperatively. Stroke rates were 5.7% (ablation) and 9.1% (control) (P = 0.3083). There was no significant difference in stroke-free survival [hazard ratio (HR) = 0.99, 95% CI 0.64–1.53; P = 0.949] nor in serious adverse events, operative or overall survival, cardioversion, pacemaker implantation, New York Heart Association, EQ-5D-3L and SF-36. The mean additional ablation cost per patient was £3533 (95% CI £1321–£5746). Cost-effectiveness was not demonstrated at 2 years.CONCLUSIONSAdjunct AF surgery is safe and increases SR restoration and costs but not survival or QoL up to 2 years. A continued follow-up will provide information on these outcomes in the longer term.Study registrationISRCTN82731440 (project number 07/01/34).

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“…In our study, LAAEF in Group SR was at the lowest level of the normal range at 1 week postoperation and experienced no significant change at 3 months postoperation. We calculated that volume parameters reflecting LA function were relatively insensitive to early predictions of disease relative to Doppler and strain analyses as was mentioned in a previous study (28). Therefore, to accurately evaluate the recovery of LA contractile function, we should also observe the recovery of LA electromechanical coupling.…”

Section: Effects Of the Surgery On La Functionmentioning

confidence: 90%

Impact of stand-alone minimally invasive radiofrequency ablation with left atrial appendectomy on left atrial function assessed by echocardiography

Zhang

Sun

et al. 2020

Quant Imaging Med Surg

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Background: Stand-alone minimally invasive radiofrequency (RF) ablation with left atrial (LA) appendectomy has been an effective surgical intervention for non-paroxysmal atrial fibrillation (AF) (NPAF) in patients with a medical history of thromboembolism for secondary stroke prevention. This study sought to assess the impact of this surgery on LA function.Methods: A total of 37 NPAF patients with a medical history of stroke or thromboembolism were enrolled in this prospective observational study, all of whom underwent stand-alone minimally RF ablation with LA appendectomy. Echocardiography was used to evaluate LA function preoperatively and 1 week and 3 months postoperatively. All patients were divided into two groups (Group AF and Group SR) according to whether sinus rhythm (SR) was restored after the surgery. Results:The surgery had no impact on LA function in Group AF. Once NPAF patients were restored to SR, LA minimal volume (LAV min ) decreased immediately compared with pre-operation (22.98±13.76 vs. 17.68±9.52 mL; P<0.05) and consequently LA reservoir function increased, including LAEF (37.69%±12.53% vs. 46.71%±8.53%, P<0.05) and LAEI (66.54%±34.39% vs. 92.15%±31.37%, P<0.05). PA-TDI of Group SR, indicating LA electromechanical coupling, were improved at three months of follow-up because of atrial stunning after the surgery (160.55±26.19 vs. 143.82±20.923 ms, P<0.05). LA contractile function was also improved at three months of follow-up (A-TVI: 2.95±1.16 vs. 5.10±1.85 cm, P<0.05).Conclusions: Stand-alone minimal invasive RF ablation with LA appendectomy had no impact on LA function in AF patients who could not be restored to SR. However, once AF patients were restored to SR after the surgery, LA function could recover better. Meanwhile, thromboembolic events could also be reduced after the surgery.

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Recovery of Left Atrial Contractile Function After Maze Surgery in Persistent Longstanding Atrial Fibrillation

Cited by 9 publications

References 3 publications

Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

Amaze: a randomized controlled trial of adjunct surgery for atrial fibrillation†

Impact of stand-alone minimally invasive radiofrequency ablation with left atrial appendectomy on left atrial function assessed by echocardiography

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