Safety and efficacy of concomitant ablation for atrial fibrillation in rheumatic mitral valve surgery: A meta‐analysis

Abstract

Objectives: This review aimed to evaluate the safety and efficacy of concomitant surgical ablation (SA) for patients with atrial fibrillation (AF) undergoing rheumatic mitral valve (MV) surgery.Methods: A systematic search of relevant studies focusing on SA for patients with AF undergoing rheumatic MV surgery was performed. The primary outcomes included mortality, efficacy, and complications.Results: Four randomized controlled trials (RCTs) and four observational studies covering 1931 patients met the inclusion criteria. In RCTs, no significant differences in reoperation for bleeding, low cardiac output syndrome, thromboembolic events, and early (risk ratio [RR], 2.07; 95% confidence intervals [CI], 0.37-11.40; p = .41) and midterm all-cause death (RR, 1.07; 95% CI, 0.40-2.88; p = .89) were noted between the SA group and the nonablation group. These results were similar to those obtained from observational studies. However, ablation was associated with a higher incidence of permanent pacemaker implantation (RR, 2.44; 95% CI, 1.15-5.18; p = .02) in observational studies but not in RCTs (RR, 2.03; 95% CI, 0.19-21.26; p = .56). Furthermore, additional SA was significantly more effective in sinus rhythm (SR) restoration than MV surgery alone at discharge and at the 12-month and 3-year follow-ups.Conclusions: Concomitant SA during rheumatic MV surgery does not increase perioperative adverse events. In addition, SA promotes considerable restoration of SR. Although some evidence exists that permanent pacemaker implantation is more common after ablation, not all studies support this notion.

Preoperative predictors of postoperative atrial fibrillation in patients undergoing cardiopulmonary bypass

“…In addition to increasing the risk of mortality, it also causes socioeconomic problems by causing morbid consequences such as heart failure and stroke. 1 47.6%, specificity: 77.6%). 3…”

“…Atrial fibrillation (AF) is the most common arrhythmia with a prevalence ranging from 2% to 4% in the adult population. In addition to increasing the risk of mortality, it also causes socioeconomic problems by causing morbid consequences such as heart failure and stroke 1 . Postoperative atrial fibrillation (PoAF) is a frequent complication ranging from 10% to 60% after major surgical interventions (cardiac surgery, pulmonary thromboendarterectomy [PTE], aortic surgery, etc.)…”

Management of atrial fibrillation in rheumatic heart disease

“…Concomitant SA during rheumatic MV surgery does not increase perioperative adverse events more effective in sinus rhythm restoration than MV surgery alone at discharge and 1- and 3-year follow-up. 52 Surgical AF ablation has a class IIa recommendation in patients with valvular heart disease undergoing surgery in the recent AF guidelines. 4 …”

Bi-atrial versus left atrial ablation for patients with rheumatic mitral valve disease and non-paroxysmal atrial fibrillation (ABLATION): rationale, design and study protocol for a multicentre randomised controlled trial

“…10 Similarly, some studies concluded that the additional surgical ablation also decreased the risk of stroke or death and increased early and long-term sinus rhythm maintenance in patients with AF and RMVD. [11][12][13] However, there has been debate on the standard surgical ablation strategy during MV operations. Generally, bi-atrial (BA) lesion set could be created during surgical ablation because the open left atrium facilitates a BA ablation procedure, nevertheless, others believed that adding right atrial ablation had no influence on freedom from AF and conversely increased the risk of permanent pacemaker implantation.…”

“…Gillinov et al reported the addition of surgical ablation to MV surgery significantly increased the rate of freedom from AF at 1 year among patients with persistent or long-standing persistent AF in a multicentre randomised controlled trial (RCT) 10. Similarly, some studies concluded that the additional surgical ablation also decreased the risk of stroke or death and increased early and long-term sinus rhythm maintenance in patients with AF and RMVD 11–13…”