Mid-term outcomes of concomitant surgical ablation of atrial fibrillation in patients undergoing cardiac surgery for hypertrophic cardiomyopathy†

Lapenna, Elisabetta; Pozzoli, Alberto; Bonis, Michele De; Canna, Giovanni La; Nisi, Teodora; Nascimbene, Simona; Vicentini, Luca; Sanzo, Stefania Di; Forno, Benedetto Del; Schiavi, Davide; Alfieri, Ottavio

doi:10.1093/ejcts/ezx017

Cited by 25 publications

(19 citation statements)

References 25 publications

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“…In this study, the rate of AF freedom was 89% (40 patients) at 1 year and 78% (35 patients) at 24 months, and each ablation line was ablated 8–10 times. According to Lapenna et al ( 12 ), the SR maintenance rate of 31 patients with HOCM combined with persistent AF could reach 96 ± 3.5% and 80 ± 8.1% at 1- and 6-year arrhythmia control (maintenance of SR with or without AADs) after septal myectomy and surgical ablation. We also calculated the maintenance of the SR.…”

Section: Discussionmentioning

confidence: 99%

“…In view of the low incidence rate of HOCM and the small number of such operations, our total surgical volume was relatively high. Previous studies ( 10 – 12 ) on the surgical treatment of patients with HOCM and AF were mostly retrospective observational studies. Our study included patients with HOCM and AF who underwent isolated septal myectomy for various reasons in our center and were compared with patients who underwent the Cox-maze IV procedure at the same time, which further confirmed the necessity of the Cox-maze IV procedure for such patients.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

Meng

Zhang

Liu

et al. 2021

Front. Cardiovasc. Med.

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Objective: Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.Methods: Ninety-four patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent septal myectomy were analyzed, we divided it into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox maze operation (no Cox-maze group). Freedom from atrial fibrillation recurrence and all-cause mortality after surgery were assessed.Results: Freedom from all-cause mortality after septal myectomy at 1, 3, and 5 years was 98.5 ± 1.5% each in the Cox-maze group and 90.8 ± 6.3%, 85.1 ± 8.1%, and 85.1 ± 8.1%, respectively, in the no Cox-maze group. Patients in the no Cox-maze group had lower survival, freedom from atrial fibrillation recurrence off antiarrhythmic drugs, and arrhythmia control rate (including patients with successful antiarrhythmic drug conversion) than those in the Cox-maze group (P = 0.046, P = 0.040, and P = 0.012, respectively). Patients who underwent the Cox-maze IV procedure had lower atrial fibrillation recurrence rate than those who did not (hazard ratio, 0.141; 95% confidence interval, 0.042–0.479; P = 0.002). Post-operative increases in left atrial diameters (hazard ratio, 1.099; 95% confidence interval, 1.024–1.179; P = 0.009) were associated with atrial fibrillation recurrence.Conclusions: The Cox-maze IV procedure combined with septal myectomy improved mid-term survival and reduced mid-term atrial fibrillation recurrence in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. The concomitant Cox-maze IV procedure was associated with a lower atrial fibrillation recurrence in patients with surgical hypertrophic obstructive cardiomyopathy and atrial fibrillation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

Meng

Zhang

Liu

et al. 2021

Front. Cardiovasc. Med.

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“…[699][700][701][702][703][704][705][706] In subjects with HCM and AF who undergo surgical myectomy a concomitant Cox-Maze procedure might be considered. 707,708 Anticoagulation management of patients with HCM are discussed in section 8.3.7.…”

Section: Hypertrophic Cardiomyopathymentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

361

496

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The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published R ESUM ELe programme de lignes directrices de la Soci et e canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a et e elabor e pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les d ecideurs politiques et les systèmes de soins de sant e sur des questions connexes. La dernière edition

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“…Studies investigating the efficacy of concomitant AF surgery during myectomy are limited [30][31][32][33]. Therefore, according to the guidelines, concomitant AF ablation during septal myectomy is considered as a class 2A indication (evidence level C).…”

Section: Concomitant Af Surgery Enough Evidence To Perform?mentioning

confidence: 99%

Early and late post-operative arrhythmias after surgical myectomy: 45 years of follow-up

Kharbanda

Lodder

Ragab

et al. 2021

International Journal of Cardiology

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Aims: The aims of this study are to investigate the incidence and determinants of post-operative atrial arrhythmias, conduction disorders and mortality in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing transaortic myectomy. Methods and results: This retrospective single-center study was conducted in 249 patients (median age 54 years , 42% female) undergoing transaortic myectomy. Post-operative atrial fibrillation (AF) was reported in 84 patients (33.7%), including 56 patients (22.5%) with de novo AF. Older age (HR = 1.027 (1.003-1.052), p = 0.029) and hypercholesterolemia (HR = 2.296 (1.091-4.832) p = 0.029) were independent predictors for de novo post-operative AF. Late post-operative AF and atrial flutter (AFL) occurred in 18.9% and 6.8% of the patients, respectively. De novo early post-operative AF increased the risk of late post-operative AF (HR = 3.138 (1.450-6.789), p = 0.004). Patients with a right bundle branch block had a higher risk of early-postoperative pacemaker implantation (p = 0.003, HR = 9.771 (2.195-43.505)). Higher age at time of surgery (HR = 1.053 (1.026-1.081), p < 0.001) was a predictor for late mortality (n = 47, 18.9%). Conclusion:Early and late post-operative AF, AFL and other SVTs are common sequelae after myectomy and are associated with older age at surgery, history of AF and early post-operative AF. Early post-operative arrhythmias are not transient and periodic rhythm monitoring is therefore essential to initiate therapy as soon as possible.

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Mid-term outcomes of concomitant surgical ablation of atrial fibrillation in patients undergoing cardiac surgery for hypertrophic cardiomyopathy†

Abstract: Concomitant surgical ablation of AF is a reasonable treatment option for drug refractory AF in patients with HCM undergoing surgical myectomy and/or mitral valve surgery. However, chronic antiarrhythmic drugs are needed to achieve a satisfactory mid-term arrhythmia control.

Cited by 25 publications

References 25 publications

Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Early and late post-operative arrhythmias after surgical myectomy: 45 years of follow-up

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