Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis

Phan, Kevin; Xie, Ashleigh; Tsai, Yi Chin; Kumar, Narendra; Meir, Mark La; Yan, Tristan D.

doi:10.1093/europace/euu220

Cited by 52 publications

(50 citation statements)

References 28 publications

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“…Although promising, these results are suboptimal, particularly in patients with persistent and long-standing persistent AF (10)(11)(12), which is partly due to the lack of transmurality in some lesions as well as gaps in ablation. In some cases of persistent or long-standing AF or AF refractory to medical and catheter ablation, surgical ablation offers an alternative option (13)(14)(15)(16)(17)(18). In the FAST randomized controlled study (19), it was demonstrated that the video-assisted surgical approach may achieve superior success rates to catheter ablation in the short term, although the patient is at risk of higher procedural complications including pneumothorax, major bleeding and pacemaker requirements.…”

Section: Original Articlementioning

confidence: 99%

Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

Phan¹,

Pison

Wang

et al. 2017

J. Thorac. Dis.

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Background: We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial ablation technique for the treatment of atrial fibrillation (AF) in obese versus non-obese patients.Methods: Between January 2010 and January 2015, a cohort of 61 patients were retrospectively identified to undergo ablation of AF as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3, 6 months, 1 year and yearly thereafter.Results: A total of 40% of the obese cohort had persistent or long-standing AF, compared to 54.9% of the non-obese cohort. There were no deaths or conversion to cardiopulmonary bypass required. At 3-year follow-up, 60% of the obese group were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting 30 s off anti-arrhythmic drugs. This was compared to 70.6% in the non-obese group, with no significant difference between the groups (P=0.468). For success rates on anti-arrhythmic drugs, this was 80% in the obese group compared to 86% in the non-obese group at 3-year follow-up (P=0.637). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up. Conclusions:In a retrospective cohort with approximately half with persistent or long-standing AF, thoracoscopic hybrid epicardial endocardial ablation proved to be equally effective and safe in obese versus non-obese patients. Current preliminary findings require further validation in multi-institutional prospective studies with larger sample sizes.

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Section: Original Articlementioning

confidence: 99%

Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

Phan¹,

Pison

Wang

et al. 2017

J. Thorac. Dis.

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“…Patients with new-onset paroxysmal AF can achieve AF ablation with pulmonary vein isolation lesion, whereas those with recent onset paroxysmal AF or those undergoing non-right heart surgery can achieve ablation with a left atrial lesion. Patients with longstanding symptomatic AF or AF in young patients undergoing right heart surgery are likely to benefit from biatrial lesions-which are the most effective (114,115).…”

Section: Types Of Lesionsmentioning

confidence: 99%

Atrial fibrillation: review of current treatment strategies

Xu¹,

Luc²,

Phan³

2016

J. Thorac. Dis.

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

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“…16 Limiting ablations to the left atrium has the potential for less postoperative bradycardias and atrial flutters. A meta-analysis of 10 randomized and observational studies 17 showed a significant reduction in the need for permanent pacing with left atrial ablation compared with biatrial ablations. Biatrial ablation was more effective in maintenance of sinus rhythm at 1 year, although this advantage was not maintained beyond the first year.…”

Section: Outcomes In Comparative Studiesmentioning

confidence: 99%

Patients with Minimal Atrial Fibrillation Events Should Not Undergo Concomitant Atrial Ablation During Open Heart Procedures

Padanilam

Foreman

Prystowsky

2015

Cardiac Electrophysiology Clinics

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Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis

Cited by 52 publications

References 28 publications

Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

Atrial fibrillation: review of current treatment strategies

Patients with Minimal Atrial Fibrillation Events Should Not Undergo Concomitant Atrial Ablation During Open Heart Procedures

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