Late results after stand-alone surgical ablation for atrial fibrillation

MacGregor, Robert M.; Bakir, Nadia H.; Pedamallu, Havisha; Sinn, Laurie A.; Maniar, Hersh S.; Melby, Spencer J.; Damiano, Ralph J.

doi:10.1016/j.jtcvs.2021.03.109

Cited by 12 publications

(6 citation statements)

References 38 publications

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“…8,18,[21][22][23]26 This has significantly shortened the cross-clamp times and lowered both the morbidity and mortality while preserving the excellent late outcomes of the CMP. 7,[9][10][11][12][30][31][32] In our recent study examining the late outcomes in 853 patients, the 5-year and 10-year freedom from recurrent ATAs was 84% and 77%, respectively. 6 With the introduction of the CMP-IV, there has been a widespread adoption of surgical ablation by surgeons, with case volumes going from only several hundred per year 20 years ago to almost 50,000 cases last year.…”

Section: Discussionmentioning

confidence: 96%

“…8,18,21–23,26 This has significantly shortened the cross-clamp times and lowered both the morbidity and mortality while preserving the excellent late outcomes of the CMP. 7,9–12,30–32 In our recent study examining the late outcomes in 853 patients, the 5-year and 10-year freedom from recurrent ATAs was 84% and 77%, respectively. 6…”

Section: Discussionmentioning

confidence: 98%

“…6–8 The long-term clinical results of both the stand-alone and concomitant CMP-IV are excellent, with 83% to 89% freedom from atrial tachyarrhythmias (ATA) after 5 years. 6,9–11 Furthermore, there was a 20% survival benefit at 10 years, without increased perioperative morbidity, in patients with AF who underwent concomitant CMP-IV compared with those who underwent cardiac surgery alone. 12…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Novel Bipolar Radiofrequency Clamp: An Acute Porcine Model

Yates

McGilvray

Razo

et al. 2022

Innovations�(Phila)

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Objective: Expert consensus guidelines recommend surgical ablation (SA) for patients with symptomatic atrial fibrillation (AF), but less than half of patients with AF undergoing cardiac procedures receive concomitant SA. Complete isolation of the left atrial posterior wall (LAPW) has been shown to be the most critical part of the Cox maze procedure. The purpose of this study was to investigate the performance of a novel radiofrequency (RF) bipolar device, EnCompass™ (AtriCure, Inc., Mason, OH, USA), designed to isolate the LAPW in a single application. Methods: Five adult pigs underwent SA in a beating heart model. After a single ablation, the heart was arrested, explanted, and stained with triphenyl-tetrazolium-chloride for histological assessment. Each lesion was sectioned, and the ablation depth, muscle, and fat thickness were determined. The lesion width, energy delivery, and ablation times were compared with those from a reference RF clamp (Synergy™, AtriCure). Results: Transmurality was documented in 100% of lesions (5 of 5) and cross sections (160 of 160). Electrical isolation was documented in every instance. There was no evidence of clot, charring, or pulmonary vein stenosis. Compared with the reference clamp, the lesions created by the EnCompass™ clamp were 1.5 times wider on average. The average energy delivered was 5 times higher over a duration that was 4.5 times longer due to the increased volume of tissue ablated. Conclusions: The EnCompass™ clamp reproducibly created transmural isolation of the LAPW with a single application. This may allow for simplification of the SA strategy and increased adoption of AF treatment during concomitant surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Efficacy of a Novel Bipolar Radiofrequency Clamp: An Acute Porcine Model

Yates

McGilvray

Razo

et al. 2022

Innovations�(Phila)

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“…The rate of PMI after surgical ablation (Cox-maze IV procedure) for AF was reported to be 6%−7%. [17][18][19] Compared with surgical ablation, the rate of permanent PMI was considerably lower after RFCA.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, postoperative bradycardia requiring PMI is a known complication after surgical AF ablation. The rate of PMI after surgical ablation (Cox‐maze IV procedure) for AF was reported to be 6%−7% 17–19 . Compared with surgical ablation, the rate of permanent PMI was considerably lower after RFCA.…”

Section: Discussionmentioning

confidence: 99%

Predictors of pacemaker implantation within three months after catheter ablation of atrial fibrillation

Guo

Chen

Yang

et al. 2023

Pacing Clinical Electrophis

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Background: It is inevitable for patients to have a temporary or permanent pacemaker implanted during or after radiofrequency catheter ablation (RFCA) for treatment of atrial fibrillation (AF) in some cases. The aim of our study was to evaluate the incidence of pacemaker implantation (PMI) during or within 3 months of RFCA for AF and to identify the risk factors that were associated with PMI. Methods:We performed a retrospective analysis of consecutive AF patients who underwent RFCA between August 2018 and October 2020 at our center. The incidence of PMI within 3 months during or after RFCA were assessed. A multivariate logistic regression model was performed to identify predictors of PMI.Results: One thousand and five patients (mean age, 60.2 ± 10.3 years; 37.6% women) were included in this analysis. PVI was performed in all patients. A total of 23 (2.3%) patients had a pacemaker implanted within 3 months during or after ablation. Multivariable logistic regression analysis revealed that older age (OR: 1.08 [95% CI 1.03-1.13], p = .003), female sex (OR: 3.08 [95% CI 1.28-7.45], p = .012), paroxysmal AF (OR: 4.71 [95% CI 1.09-20.45], p = .038) and repeated ablation (OR: 2.78 [95% CI 1.04-7.40], p = .041) were the independent predictors for PMI. Conclusions:Older age, female sex, paroxysmal AF and repeated ablation were identified as predictive risk factors for PMI after RFCA in patients with AF. A "watch and wait" strategy could be taken for patients with temporary PMI after ablation, especially for those with prolonged sinus pause after AF termination.

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