Catheter Versus Surgical Ablation of Atrial Fibrillation After a Failed Initial Pulmonary Vein Isolation Procedure: A Randomized Controlled Trial

Abstract

In patients with PAF and PersAF after failed initial CA, SA is superior to CA for maintenance of sinus rhythm, although serious adverse event rate is significantly higher for SA.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…585,586,601,602 A meta-analysis of these and other observational studies demonstrated a significant improvement of arrhythmia-free survival for the VATS procedure (78.4 vs 53%; RR 1.54; 95% CI 1.50–2.14; I 2 = 0%; P <.0001), with a clearer benefit for patients with persistent AF. 603 Complications were three times more frequent in the VATS group, mostly due to pneumothorax and pleural effusion.…”

Atrial Arrhythmias Following Surgical AF Ablation: Electrophysiological Findings, Ablation Strategies, and Clinical Outcome

“…Intraoperative ablation of atrial fibrillation (AF) has been predominantly performed as a concomitant antiarrhythmic procedure . Recently, however, clinical and scientific interests of both electrophysiologists and cardiac surgeons have led to a revival of this procedure, not only as a concomitant practice, but also as a stand‐alone therapy for AF . Patients with an advanced atrial electrical disease and those with multiple unsuccessful catheter‐based interventions are thought to be potential candidates for antiarrhythmic surgery .…”

“…Recently, however, clinical and scientific interests of both electrophysiologists and cardiac surgeons have led to a revival of this procedure, not only as a concomitant practice, but also as a stand‐alone therapy for AF . Patients with an advanced atrial electrical disease and those with multiple unsuccessful catheter‐based interventions are thought to be potential candidates for antiarrhythmic surgery . While the optimal lesion pattern still remains a matter of debate, comparative studies have revealed the importance of left atrial ablations, including pulmonary vein (PV) isolation (PVI) .…”

Iatrogenic atrial septal defect: reassurance or inquisitiveness

“…Autonomic system plays an important role in the pathogenesis of AF, although the effectiveness of autonomic modification for treatment of AF remains controversial [29]. Randomized trials tested the concept of standalone epicardial ablation in patients mostly with permanent AF who had recurrent AF after traditional endocardial approach proved reasonable efficacy [30,31]. Catheter-free ablation is an active area of research with promising results [24][25][26][27].…”