A left atrial versus a biatrial lesion set for persistent atrial fibrillation ablation during open heart surgery†

Bogachev-Prokophiev, Alexander V; Afanasyev, Alexander; Pivkin, Alexey; Овчаров, М. А.; Железнев, С. И.; Sharifulin, Ravil; Караськов, А. М.

doi:10.1093/ejcts/ezy126

Cited by 16 publications

(23 citation statements)

References 24 publications

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“…3,4,21,22,24,25,27,31,32,37 The remaining 15 studies (53.6%) were retrospective observational, of which 3 were propensity adjusted. 5,19,20,26,[28][29][30]33,34,38,39,[44][45][46][47] In 16 studies (57.1%) all the patients enrolled presented exclusively non-paroxysmal AF forms and these studies constituted the "non-paroxysmal AF subgroup." [20][21][22][23][25][26][27][28][34][35][36][37][38][39]46,47 clearly specify the types of AF included.…”

Section: Discussionmentioning

confidence: 99%

“…Discrepancies between reviewers were resolved by group discussion. At this stage, 7392 articles were excluded because they did not match study criteria while 37 articles were reviewed at full‐text level. The references of these articles were screened and 8 more articles were identified reaching 45 articles assessed at full‐text level: of these, 17 were excluded for the following reasons: (a) despite reporting the use of BA and LA approaches in 8 studies there was no clear separation of at least one outcome for the two groups, only one type (BA or LA) of ablation approach reported for 6 studies, patients populations overlapping with studies already included for 3 studies, leaving in total 28 studies suitable to be included in this meta‐analysis …”

Section: Methodsmentioning

confidence: 99%

“…,21,23,[25][26][27][28]32,36,46 while in the remaining studies various types of main procedures (coronary surgery, valve surgery, aortic surgery, etc) were performed aside of AF ablation. Four studies23,28,36,47 enrolled only patients rheumatic valve disease (RVD) in both study groups, while 4 more studies21,27,32,37 reported a variable quota of RVD ranging between 50% and 70% of the population, while in the remaining 20 studies the incidence of RVD was not clearly stated.In 25 studies (89.3%) the same type of ablation energies were used in both BA and LA groups 5,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][44][45][46][47]. A CM4 procedure, using different types of energies, was performed in all except five studies: of these five,Takami38 and Takasaki 27 performed a CM3 procedure ("cut and sew" technique) with some of the lesions achieved using cryoablation.…”

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confidence: 99%

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Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Cappabianca

Ferrarese

Tutino

et al. 2019

Cardiovasc electrophysiol

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Introduction The latest STS guidelines recommend concomitant atrial fibrillation (AF) ablation not only during mitral surgery (Class IA) but also during other‐than‐mitral cardiac surgery procedures (Class IB) in patients with preoperative AF. Conventional Cox‐Maze III/IV procedures are performed on both atria (BA), but several studies reported excellent results with left atrial only (LA) ablations: the scope of this study is to compare the safety and efficacy of BA vs LA approach. Methods and Results Pubmed, Scopus, and WOS were searched from inception to November 2018: 28 studies including 7065 patients and comparing the performance of BA vs LA approaches were identified: of these, 16 (57.1%) enrolled exclusively patients with non‐paroxysmal AF forms, 10 (35.7%) focused on mitral surgery as main procedure, and 16 (57.1%) regarded patients undergone Cox‐Maze with radiofrequency. The 6‐ and 12‐months prevalence of sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09‐1.73, P = .008 and OR, 1.37, CI, 0.99‐1.88, P = .05 respectively). Permanent pacemaker (PPM) implantation (OR, 1.85, CI, 1.38‐2.49, P < .0001) and reopening for bleeding (OR, 1.70, CI, 1.05‐2.75, P = .03) were higher in the BA group. Among patients undergone PPM implantation, BA group had a significantly higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49‐6.07, P = .002). Conclusions Concomitant BA ablation appears superior to LA ablation in terms of efficacy but is associated with a higher risk of bleeding and of PPM implantation, more frequently due to sinoatrial node dysfunction. LA approach should be preferable in patients with a higher risk of bleeding or with perioperative risk factors for PPM implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Cappabianca

Ferrarese

Tutino

et al. 2019

Cardiovasc electrophysiol

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“…Churyla и соавт. [23] доложили о результатах исследования 147 пар пациентов, полученных методом псевдорандомизации, которым были выполнены ЛП и БА абляции при лечении различных типов ФП одномоментно с коррекцией митрального порока. В отличие от нашего исследования, они не обнаружили значительных различий между ЛП и БА схемами по свободе от ФП (69% против 79%; р=0,09) в отдаленном периоде.…”

Section: Discussionunclassified

Comparative efficacy of biatrial and left atrial surgical ablation for atrial fibrillation

Bogachev-Prokofiyev¹,

Afanasiyev²,

Sharifulin³

et al. 2018

Kardiol. serdechno-sosud. khir.

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Цель исследования-сравнить результаты одномоментной биатриальной (БА) и левопредсердной (ЛП) хирургической абляции предсердий, проводимой у пациентов с приобретенным пороком митрального клапана, осложненным персистирующей и длительно персистирующей фибрилляцией предсердий (ФП). Материал и методы. За период с января 2007 г. по декабрь 2016 г. в исследование были включены 588 пациентов с персистирующей (20,9%) и длительно персистирующей ФП (79,1%). С целью исключения различий между группами была выполнена псевдорандомизация, и получены две группы (156 пациентов в каждой группе) со схожими предоперационными и послеоперационными характеристиками. Результаты. После псевдорандомизации БА и ЛП группы не имели значимых отличий по 30-дневной летальности (1,9% против 0,6%; p=0,617), общей 5-летней выживаемости (93,5±2,2% против 92,8±2,9%; p=0,998), а также летальности, связанной с тромбоэмболическими осложнениями (97,1±2,8% против 96,2±2,7%; p=0,309). БА схема фрагментации была ассоциирована с более высокой степенью свободы от возврата предсердных аритмий (85,3±4,5% против 91,9±3,1%; p=0,049; отношение рисков (OR) 3.26, 95% ДИ 1,33-7,99). Заключение. Обе схемы фрагментации предсердий имели схожие показатели 30-дневной летальности, выживаемости, частоту тромбоэмболических осложнений. У пациентов с персистирующей ФП биатриальная схема хирургической абляции способствует более высоким показателям свободы от возврата предсердных нарушений ритма.

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“…У больных с персистирующими и длительно персистирующими вариантами ФП, прооперированных по поводу наличия митральных пороков с сопутствующей хирургической аблацией, БА обеспечила лучшую свободу от рецидивов аритмии предсердий, но и была связана с более высокой частотой имплантации ЭКС в связи с дисфункцией синусного узла [55].…”

Section: сравнение двух методик -аблации изолированного левого предсеunclassified

Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

Калыбекова¹,

Chernyavskiy²

2019

AnnAritmol

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Among patients with coronary heart disease or acquired heart valvular disease requiring surgical treatment, the prevalence of atrial fibrillation (AF) is up to 85%. The presence of concomitant atrial fibrillation increases the risk of postoperative complications, including fatal ones, worsens the prognosis of postoperative survival and the quality of life of patients. Surgical ablation in AF significantly prolongs the maintenance of sinus rhythm and is recommended as a concomitant procedure in patients requiring surgical correction of an open heart. To date, there is no single method for the surgical treatment of AF in the open heart surgery. Patients with ischemic heart disease or mitral valvular disease and concomitant AF are recommended for open heart ablation. Much research has been devoted to the ablation of two atria at once, which have shown their effectiveness in comparison with the ablation of an isolated left atrium, including the safety of the method of twoatrial surgical ablation. We conducted a systematic review based on meta-analyzes, randomized clinical trials, including comparative characteristics of two surgical treatments for AF in concomitant cardiovascular diseases such as coronary artery disease and acquired heart disease. The main purpose of this review was to compare two methods (biatrial and left atrial) of ablation, as a concomitant surgical procedure for open heart surgery in patients with coronary heart disease and acquired heart disease, complicated by long-term persistent atrial fibrillation. We used PubMed, Cochrane central, Publons, and Medline search systems from March to September 2019, evaluating surgical ablation of AF, including biatrial or isolated left atrial ablation on patients requiring and going for open heart surgery. Surgical ablation of AF combined with concomitant open heart surgery has showed excellent results, where freedom from atrial fibrillation in the long-term postoperative period was noted. Among surgical ablation techniques, biatrial ablation was more effective than left atrial, although the frequency of permanent pacemaker implantation was higher in the biatrial ablation group. In most studies, endpoints important to the patient, including mortality and stroke, did not differ in both groups.

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A left atrial versus a biatrial lesion set for persistent atrial fibrillation ablation during open heart surgery†

Cited by 16 publications

References 24 publications

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

Comparative efficacy of biatrial and left atrial surgical ablation for atrial fibrillation

Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

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