Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

Breda, João Roberto; Ragognette, Ricardo Gitti; Breda, Ana Silvia Castaldi Ragognetti; Gurian, Danilo Bortolloto; Horiuti, Louise; Machado, Leandro Neves; Freitas, Andréa Cristina de Oliveira; Pires, Ana Maria

doi:10.1590/s0102-76382010000100012

Cited by 6 publications

(10 citation statements)

References 19 publications

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“…Only two approaches can modify the atrial substrate [26] . The first, through the creation of linear transmural lesions that connect two anatomical structures and form a conduction block (interrupting the re-entry circuits that perpetuate the arrhythmia).…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Chavez¹,

Colafranceschi²,

Monteiro³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveTo assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated.MethodsRetrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated.ResultsAfter one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%.ConclusionAtrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Chavez¹,

Colafranceschi²,

Monteiro³

et al. 2017

Braz J Cardiovasc Surg

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“…The main factors involved in the failure of the procedure are left atrial diameter, age, long-term AF, permanent AF, incomplete ablation lines with uniatrial approach and non-transmural lesion [9][10][11].…”

Section: Resultsmentioning

confidence: 99%

“…Thus, irrigated RF as an energy source alternative to surgical ablation of AF has recognized effectiveness, with success rate of reversion to sinus rhythm that may vary between 75 and 80% [11,23,24]. In 2008, Beukema et al [25] reported medium and long-term follow-up after radiofrequency ablation associated with other cardiac surgery and demonstrated maintenance of sinus rhythm in 69% of patients treated at 1 year follow-up, 56% in 3 years, 52% in 5 years , and 57% in later periods.…”

Section: Radio Frequencymentioning

confidence: 99%

Tratamento operatório da fibrilação atrial

Breda¹,

Ribeiro²

2011

Rev Bras Cir Cardiovasc

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When atrial fibrillation (AF) is present in pre-operative open heart surgeries, including coronary artery bypass grafting and valve operations, it represents an independent risk factor for cardiac events and reduced survival. Due to the complexity of the subject, especially when evaluating success rates (reversion and maintenance of normal sinus rhythm), a consensus statement was recently proposed by the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS), in order to determine whether the intraoperative ablation of AF promotes favorable clinical outcomes in patients undergoing other cardiac operations in comparison with individual operations without ablation. The aim of this paper is to present published data which has contributed to consensus statement and can be useful as update source. The integrative review was the methodology that provides synthesis of knowledge and applicability of results of significant studies about presented topic. Descriptors

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“…(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.…”

Section: )mentioning

confidence: 99%

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

Cappabianca

Ferrarese

Tutino

et al. 2019

Cardiovasc electrophysiol

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Introduction The latest STS guidelines recommend concomitant atrial fibrillation (AF) ablation not only during mitral surgery (Class IA) but also during other‐than‐mitral cardiac surgery procedures (Class IB) in patients with preoperative AF. Conventional Cox‐Maze III/IV procedures are performed on both atria (BA), but several studies reported excellent results with left atrial only (LA) ablations: the scope of this study is to compare the safety and efficacy of BA vs LA approach. Methods and Results Pubmed, Scopus, and WOS were searched from inception to November 2018: 28 studies including 7065 patients and comparing the performance of BA vs LA approaches were identified: of these, 16 (57.1%) enrolled exclusively patients with non‐paroxysmal AF forms, 10 (35.7%) focused on mitral surgery as main procedure, and 16 (57.1%) regarded patients undergone Cox‐Maze with radiofrequency. The 6‐ and 12‐months prevalence of sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09‐1.73, P = .008 and OR, 1.37, CI, 0.99‐1.88, P = .05 respectively). Permanent pacemaker (PPM) implantation (OR, 1.85, CI, 1.38‐2.49, P < .0001) and reopening for bleeding (OR, 1.70, CI, 1.05‐2.75, P = .03) were higher in the BA group. Among patients undergone PPM implantation, BA group had a significantly higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49‐6.07, P = .002). Conclusions Concomitant BA ablation appears superior to LA ablation in terms of efficacy but is associated with a higher risk of bleeding and of PPM implantation, more frequently due to sinoatrial node dysfunction. LA approach should be preferable in patients with a higher risk of bleeding or with perioperative risk factors for PPM implantation.

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Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

Cited by 6 publications

References 19 publications

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Tratamento operatório da fibrilação atrial

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

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