Comparison of Surgical Cut and Sew versus Radiofrequency Pulmonary Veins Isolation for Chronic Permanent Atrial Fibrillation: A Randomized Study

Pires, Leonardo Martins; Leiria, Tiago Luiz Luz; Lima, Gustavo Glotz de; Kruse, Marcelo Lapa; Nesralla, Ivo A.; Kalil, Renato A. K.

doi:10.1111/j.1540-8159.2010.02805.x

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…All septal veins demonstrated gaps and the lateral veins were isolated at a level to distal in the vein leaving the antrum untreated. Recent insight from a new strategy supports this view; a "cutand-sew" strategy will render continuous lines of block and revealed significantly better AF-free survival than surgical ablation [18]. Therefore we believe that the unsatisfactory results from uncontrolled isolation of veins lack control by conduction testing.…”

Section: Discussionmentioning

confidence: 91%

Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences

Tischer

Schneider

Lauschke

et al. 2015

Herzschr Elektrophys

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Section: Discussionmentioning

confidence: 91%

Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences

Tischer

Schneider

Lauschke

et al. 2015

Herzschr Elektrophys

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“…The histologic interpretation in acute and early phase certainly underestimates the importance of the lesion [13], and the electrophysiologic consequences of scarring induced late after the procedure. Otherwise, the clinical efficacy of transmurality was also questioned by some clinical and experimental studies [12,14-18]. Several hypotheses were raised: new concepts of electro-anatomic remodeling of the atria associated with the use of these energy sources; no justification of transmurality of lesions according to the endocardial or epicardial site of delivery of energy or the type of AF (permanent or paroxysmal) [19]?…”

Section: Discussionmentioning

confidence: 99%

Human comparative experimental study of surgical treatment of atrial fibrillation by epicardial techniques

Arid

Sénage

Toquet³

et al. 2013

J Cardiothorac Surg

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BackgroundTo set up an experimental model of cadaveric heart in order to evaluate and compare histologic transmurality of lesions immediately caused by different energy sources of anti-arrhythmic epicardial devices.MethodsProcedures were performed on a cadaveric human heart in orthotopic position with an ischemic time of 48 h at 37° and supported through the use of cardiopulmonary bypass. Three anti-arrhythmic epicardial devices were studied: the bipolar forceps Cardioblate BP (Medtronic) for the radiofrequency, the Epicor Ultracinch LP Ablation device (St. Jude) for ultrasound and the Cardioblate CryoFlex (Medtronic) device for cryoablation. Histological features of lesions made at the pulmonary venous confluence assessed the effectiveness of different energy sources.ResultsOver 45 experimentations performed, only 28 were considered correct and retained for histological analysis. Three distinct groups were studied according to the type of procedure performed: group 1 (Radiofrequency, n = 12), group 2 (ultrasound, n = 4), group 3 (cryoablation, n = 10) and controls (n = 2). All analysed samples showed histological changes with a success rates of transmurality of 33% for radiofrequency, 25% for ultrasound and 90% for cryotherapy (p <0.001). The average length of transmurality, when it was reached and the proportion of transmurality over the total length of the lesion were respectively 12 ± 6 mm and 37 ± 18% for group 1, 10 mm and 33% for group 2 and 11.1 ± 1.1 mm and 35 ± 5% for group 3.ConclusionImmediate detectable histological transmural lesions after epicardial procedure are discontinuous whatever the kind of energy source tested in this work and it strongly encourages the repetition of radiofrequency procedures. Nevertheless, our experimental model seems inadequate to assess ultrasound energy efficacy.

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Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

Huffman

Karmali

Berendsen

et al. 2016

Cochrane Database of Systematic Reviews

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Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random-effects model when heterogeneity was high (I2 > 50%). We evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to create a ‘Summary of findings’ table. Main results We found 34 reports of 22 trials (1899 participants) with five additional ongoing studies and three studies awaiting classification. All included studies were assessed as having high risk of bias across at least one domain. The effect of concomitant AF surgery on all-cause mortality was uncertain when compared with no concomitant AF surgery (7.0% versus 6.6%, RR 1.14, 95% CI 0.81 to 1.59, I2 = 0%, 20 trials, 1829 participants, low-quality evidence), but the intervention increased freedom from atrial fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic medications > three months (51.0% versus 24.1%, RR 2.04, 95% CI 1.63 to 2.55, I2 = 0%, eight trials, 649 participants, moderate-quality evidence). The effect of concomitant AF surgery on 30-day mortality was uncertain (2.3% versus 3.1%, RR 1.25 95% CI 0.71...

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Comparison of Surgical Cut and Sew versus Radiofrequency Pulmonary Veins Isolation for Chronic Permanent Atrial Fibrillation: A Randomized Study

Abstract: PVI by SURG formed more effective block lines than RF. SR at hospital discharge was similar among the groups, but more amiodarone was used in RF. During follow-up, incidence of recurrent AF was higher in the RF group.

Cited by 6 publications

References 22 publications

Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences

Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences

Human comparative experimental study of surgical treatment of atrial fibrillation by epicardial techniques

Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

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