Concomitant Atrial Fibrillation Surgery for People Undergoing Cardiac Surgery

Huffman, Mark D.; Malaisrie, S. Chris; Karmali, Kunal N.

doi:10.1001/jamacardio.2016.5404

Cited by 14 publications

(4 citation statements)

References 19 publications

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“…However, risk of pacemaker placement was increased (RR, 1.69 [95% CI, 1.12-2.54]). 1,2 A subsequent trial of patients undergoing mitral valve surgery with AF similarly found that ablation leads to increased freedom from AF at 1 year (63.2% versus 29.4%; P <0.001) but with increased risk of pacemaker placement (21.5 versus 8.1 per 100 patient-years; P =0.01). 3 Observational data suggest surgical ablation is associated with increased survival as well as risk of pacemaker placement and renal dysfunction.…”

Section: Rhythm Controlmentioning

confidence: 98%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

333

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AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

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Section: Rhythm Controlmentioning

confidence: 98%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

333

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“…Concomitant AF surgery approximately doubles the likelihood of freedom from AF, atrial flutter, or atrial tachycardia with a small absolute increase in needing a permanent pacemaker [ 7 ]. Surgical ablation confers significant rhythm and survival benefits without additional operative risk [ 8 ]. On the other hand, there are studies [ 9 ] that show that DM is associated with an increased risk of major adverse events.…”

Section: Introductionmentioning

confidence: 99%

Surgical ablation for atrial fibrillation: impact of Diabetes Mellitus type 2

Kogan

Grupper

Sabbag

et al. 2023

Cardiovasc Diabetol

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Background Diabetes mellitus (DM) type 2 is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with AF undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM type 2 on early and long-term outcomes of patients following surgical AF ablation. Methods We performed an observational cohort study in Israel’s largest tertiary care center. All data of patients who underwent surgical AF ablation, between 2006 and 2021 were extracted from our departmental database. Patients were divided into Group I (non-diabetic patients) and Group II (DM type 2 patients). We compared the two groups with respect to freedom from recurrent atrial arrhythmia, and mortality rate. Results The study population included 606 patients. Group I (non-DM patients), consisting of 484 patients, and Group II (DM type 2 patients), comprised 122 patients. Patients with DM were older, had more hypertension and incidence of cerebrovascular accident (CVA)/transient ischemic attack (TIA), higher EuroSCORE (p < .05 for all), and a longer bypass time—130 ± 40 vs. 122 ± 36 min (p = 0.028). The mean follow-up duration was 39.0 ± 22.7 months. Freedom from atrial fibrillation was similar between the non-DM and DM type 2 groups after a 1-year follow-up, 414 (88.2%) vs. 101 (87.1%) (p = 0.511), after a 3-year follow-up, 360 (86.3%) vs. 84 (79.9%) (p = 0.290) and after a 5-year follow-up, 226 (74.1%) vs. 55 (71.5%) (p = 0.622) respectively. Furthermore, 1- and 3-year mortality was similar between non-DM and DM type 2 groups, 2.5% vs. 4.9%, (p = 0.226) and 5.6% vs. 10.5% (p = 0.076) respectively. 5-year mortality was higher in Group II (DM type 2 patients) compared with Group I (non-DM patients), 11.1% vs. 23.4% (p = 0.009). Conclusion Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1- 3- and 5- years follow-up in both the DM type 2 and non-DM groups. Furthermore,1- and 3-year mortality after surgical ablation was also similar in both groups. However, 5-year mortality was higher in the DM type 2 group.

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“…In previous work, we showed a greater presence of LGE‐MRI lesion gaps at regions where the contact force achieved with the SmartTouch ablation catheter is weaker: the antral regions of anterior left PVs (“ridge”) and posterior right PVs . Surgical‐based techniques can achieve durable, transmural, and complete PVI and prevent AF recurrence more efficiently than catheter‐based strategies; however, surgery is highly invasive and prone to major complications . Furthermore, extensive ablation of the atrial substrate has no proven advantage, compared with PVI alone, in patients with both paroxysmal and persistent AF .…”

Section: Discussionmentioning

confidence: 99%

Postprocedural LGE‐CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation

Ventura

Mărgulescu

Benito

et al. 2018

Cardiovasc electrophysiol

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Concomitant Atrial Fibrillation Surgery for People Undergoing Cardiac Surgery

Abstract: 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.

Cited by 14 publications

References 19 publications

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Surgical ablation for atrial fibrillation: impact of Diabetes Mellitus type 2

Postprocedural LGE‐CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation

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