Medium-term outcome of different surgical methods to cure atrial fibrillation: is less worse?

Abstract

Different lesion sets and ablation techniques have been performed. We compared these outcomes in search of the best method. We performed a retrospective analysis of patients who have undergone AF surgery different from the maze III. The surgical lesion sets were pulmonary vein isolation (PVI) alone, left atrial maze (LAM) and bi-atrial maze (BAM) and were made with different ablation techniques. During surgery one patient died due to bleeding of a pulmonary vein. The number of patients in the PVI-, LAM-, BAM-groups was 12, 28 and 26, respectively, with freedom from AF at latest follow-up [22.0+/-15.6 (3.1-81.2) months] of 33%, 59% and 60%, respectively. Atrial flutter occurred less in the BAM-group (4%) than in the left-sided procedures (15.4%) (P=0.231). Multivariate analysis demonstrated a higher recurrence of AF for PVI alone (OR 4.42, CL 0.95-20.6, P=0.0583) and a lower recurrence for the 'cut-and-sew' technique (OR 0.13, CL 0.030-0.60, P=0.0084). Left- and bi-atrial maze procedures are equally effective in the suppression of AF, whereas omission of right-sided lesions results in a higher prevalence of atrial flutter. The 'cut-and-sew' technique is superior in terms of freedom from AF compared to bipolar and unipolar radiofrequency.

Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta‐analysis of clinical studies with a focus on the causes of pacemaker implantation

“…3,4,21,22,24,25,27,31,32,37 The remaining 15 studies (53.6%) were retrospective observational, of which 3 were propensity adjusted. 5,19,20,26,[28][29][30]33,34,38,39,[44][45][46][47] In 16 studies (57.1%) all the patients enrolled presented exclusively non-paroxysmal AF forms and these studies constituted the "non-paroxysmal AF subgroup." [20][21][22][23][25][26][27][28][34][35][36][37][38][39]46,47 clearly specify the types of AF included.…”

“…(a) despite reporting the use of BA and LA approaches in 8 studies there was no clear separation of at least one outcome for the two groups, [6][7][8]11,18,[41][42][43] only one type (BA or LA) of ablation approach reported for 6 studies, 9,[12][13][14][15][16] patients populations overlapping with studies already included for 3 studies, 10,17,40 leaving in total 28 studies suitable to be included in this meta-analysis. [3][4][5][44][45][46][47] 2.2 | Data extraction, selected outcomes, and subgroup analysis Data were extracted from each study by the three reviewers from the text, tables, and figures. The efficacy of BA vs LA approach was evaluated comparing: (a) prevalence of sinus rhythm (SR) at the following timeframes during the follow-up: discharge, 6 months, 1…”

“…In 10 studies (35.7%) mitral surgery was the main procedure performed in association with AF ablation, 19 Within studies adopting CM4, radiofrequency was the most common energy source used to perform the ablation: it was used in 11 studies (39.3%) as the only source of energy in both study groups, [21][22][23]25,26,34,35,37,44,45,47 while in 5 studies (17.8%) radiofrequency mainly used but it was complemented by cryoablation for some lesions. 19,20,24,30,36 These 16 studies were included in the Radiofrequency subgroup.…”

“…In 16 studies [19][20][21][22][23][24][25][26]30,[34][35][36][37]44,45,47 a CM4 using RF was adopted. The comparison of preoperative and intraoperative characteristics in this subgroup, did not show any significant unbalancing between BA and LA patients characteristics, except the length of cardiopulmonary bypass (WMD 12.16 minutes, CI, 1.53-22.80 minutes, P = .03) that was longer in the BA group (see Supplementary Material S4).…”

“…,21,23,[25][26][27][28]32,36,46 while in the remaining studies various types of main procedures (coronary surgery, valve surgery, aortic surgery, etc) were performed aside of AF ablation. Four studies23,28,36,47 enrolled only patients rheumatic valve disease (RVD) in both study groups, while 4 more studies21,27,32,37 reported a variable quota of RVD ranging between 50% and 70% of the population, while in the remaining 20 studies the incidence of RVD was not clearly stated.In 25 studies (89.3%) the same type of ablation energies were used in both BA and LA groups 5,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][44][45][46][47]. A CM4 procedure, using different types of energies, was performed in all except five studies: of these five,Takami38 and Takasaki 27 performed a CM3 procedure ("cut and sew" technique) with some of the lesions achieved using cryoablation.…”