Discontinuation of anticoagulants after successful surgical ablation of atrial fibrillation

Lauritzen, Daniel Julius; Vodstrup, Henrik J; Christensen, Thomas; Hald, Mine Onat; Christensen, Rasmus; Heiberg, Johan

doi:10.1111/jocs.14719

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…While we agree with some of the conclusions, Lauritzen et al 1 did not take into account the left atrial mechanical contraction (LAMC) to maintain or discontinue oral anticoagulation. It has been observed a very high incidence of stroke (up to 21% at 2 years) in patients who had maintained SR after cryoablation but who, for lack of effective LAMC, had undergone systematic withdrawal of anticoagulation.…”

supporting

confidence: 82%

Discontinuation of anticoagulants after surgical ablation of atrial fibrillation: Left atrial mechanical contraction matters

Martínez‐Comendador

2021

J Card Surg

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supporting

confidence: 82%

Discontinuation of anticoagulants after surgical ablation of atrial fibrillation: Left atrial mechanical contraction matters

Martínez‐Comendador

2021

J Card Surg

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“…Studies assessing post procedural success of minimally invasive surgical ablation demonstrate that the prevalence of OAC use was higher in the surgical cohorts, however this was confounded by patient bias whereby surgical cohorts have larger LAA dimensions and CHADS-VASC2 scores [ 29 ]. Lauritzen et al demonstrated that OAC’s can be safety ceased 12 months post-surgical ablation, when patients have SR maintenance and a CHADS-VASC2 score less than 2 p 30 ]. Future RCT’s exploring OAC cessation after convergent ablation would be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

Eranki

Wilson-Smith

Williams

et al. 2022

J Cardiothorac Surg

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Introduction Atrial fibrillation (AF) is the most common arrhythmia. Hybrid convergent ablation (HCA) is an emerging procedure for treating longstanding AF with promising results. HCA consists of a subxiphoid, surgical ablation followed by completion endocardial ablation. This meta-analysis of randomized control trials (RCT’s) and propensity score-matched studies aims to examine the efficacy and safety of HCA compared to endocardial catheter ablation (ECA) alone on patients with AF. Methods This review was written in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations and guidance. The primary outcome for the analysis was freedom from AF (FFAF) at final follow up. Secondary outcomes were mortality and significant complications such as tamponade, sternotomy, esophageal injury, atrio-esophageal fistulae post procedurally. Results Four studies where included, with a total of 233 patients undergoing HCA and 189 patients undergoing ECA only. Pooled analysis demonstrated that HCA cohorts had significantly higher rates of FFAF than ECA cohorts, with an OR of 2.78 (95% CI 1.82–4.24, P < 0.01, I2 = 0). Major post-operative complications were observed in significantly more patients in the HCA group, with an OR of 5.14 (95% CI 1.70–15.54, P < 0.01). There was only one death reported in the HCA cohorts, with no deaths in the ECA cohort. Conclusion HCA is associated with a significantly higher FFAF than ECA, however, it is associated with increased post-procedural complications. There was only one death in the HCA cohort. Large RCT’s comparing the HCA and ECA techniques may further validate these results.

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“…However, it can be used to help select the right candidates for surgical ablation, choose the most appropriate surgical approach such as a more complete ablation, identify patients who may need more frequent clinical and electrocardiogram controls, as well as guide choices pertaining to anticoagulation therapy. 8 In turn, this could reduce rates of AF recurrences and hospitalization costs. 11 Finally, being able to stratify patients into low-risk and high-risk groups is useful when matching expectations regarding treatment outcomes as well as for preoperative patient consent matters.…”

Section: Discussionmentioning

confidence: 99%

Scoring systems in the prediction of atrial fibrillation recurrence after surgical ablation

Lauritzen

Andersen

Modrau

et al. 2022

Journal of Cardiac Surgery

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Introduction: More than every third patient experiences recurrent atrial fibrillation after surgical pulmonary vein ablation. However, it remains challenging to predict who will and who will not experience this event. Scoring systems containing baseline risk factors have been proposed as a complementary tool to identify patients at higher risk of experiencing atrial fibrillation recurrence. Therefore, the aim of this study was to assess the value of the scoring systems APPLE, CHA 2 DS 2 -VASc, and CHADS 2 in predicting atrial fibrillation recurrence following surgical ablation.Methods: In a retrospective study, we identified all patients undergoing concomitant pulmonary vein ablation during cardiac surgery. APPLE-, CHA 2 DS 2 -VASc-, and CHADS 2 scores were calculated for each patient. Subsequently, the predictive value of the scoring systems on atrial fibrillation recurrence 3-12 months postablation was assessed using receiver operating characteristic curves and logistic regression analyses.Results: Receiver operating characteristic curves showed the superiority of the APPLE scoring system with an area under the curve of 0.690 compared to 0.571 for CHA 2 DS 2 -VASc and 0.569 for CHADS 2 , p = .01. Using logistic regression analyses, APPLE and CHA 2 DS 2 -VASc were predictors of atrial fibrillation recurrence between 3-and 12 months after surgical ablation (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.39-2.67, p < .01 and OR 1.17, 95% CI 1.01-1.36, p = .04, respectively).Conclusions: The APPLE scoring system is superior to CHA 2 DS 2 -VASc and CHADS 2 in predicting atrial fibrillation recurrence after surgical ablation. It can be used as a complementary tool to select the right candidates for surgical ablation and identify patients who need more frequent clinical and electrocardiogram controls.

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Discontinuation of anticoagulants after successful surgical ablation of atrial fibrillation

Cited by 8 publications

References 15 publications

Discontinuation of anticoagulants after surgical ablation of atrial fibrillation: Left atrial mechanical contraction matters

Discontinuation of anticoagulants after surgical ablation of atrial fibrillation: Left atrial mechanical contraction matters

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

Scoring systems in the prediction of atrial fibrillation recurrence after surgical ablation

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