Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

Abstract

Among patients with coronary heart disease or acquired heart valvular disease requiring surgical treatment, the prevalence of atrial fibrillation (AF) is up to 85%. The presence of concomitant atrial fibrillation increases the risk of postoperative complications, including fatal ones, worsens the prognosis of postoperative survival and the quality of life of patients. Surgical ablation in AF significantly prolongs the maintenance of sinus rhythm and is recommended as a concomitant procedure in patients requiring surgical correction of an open heart. To date, there is no single method for the surgical treatment of AF in the open heart surgery. Patients with ischemic heart disease or mitral valvular disease and concomitant AF are recommended for open heart ablation. Much research has been devoted to the ablation of two atria at once, which have shown their effectiveness in comparison with the ablation of an isolated left atrium, including the safety of the method of twoatrial surgical ablation. We conducted a systematic review based on meta-analyzes, randomized clinical trials, including comparative characteristics of two surgical treatments for AF in concomitant cardiovascular diseases such as coronary artery disease and acquired heart disease. The main purpose of this review was to compare two methods (biatrial and left atrial) of ablation, as a concomitant surgical procedure for open heart surgery in patients with coronary heart disease and acquired heart disease, complicated by long-term persistent atrial fibrillation. We used PubMed, Cochrane central, Publons, and Medline search systems from March to September 2019, evaluating surgical ablation of AF, including biatrial or isolated left atrial ablation on patients requiring and going for open heart surgery. Surgical ablation of AF combined with concomitant open heart surgery has showed excellent results, where freedom from atrial fibrillation in the long-term postoperative period was noted. Among surgical ablation techniques, biatrial ablation was more effective than left atrial, although the frequency of permanent pacemaker implantation was higher in the biatrial ablation group. In most studies, endpoints important to the patient, including mortality and stroke, did not differ in both groups.

Comparative efficacy and safety of biatrial versus left atrial ablation in the surgical treatment of long-standing persistent atrial fibrillation with concomitant coronary artery bypass grafting in patients with ischemic heart disease

“…В ранее описанных нами обзорах [7,8] подробно изучены все исследования ближайших 10 лет по сравнительной характеристике эффективности двух методов хирургической аблации и вариантам развития осложнений. Группой ученых [9] был проведен опрос хирургов о целесообразности выполнения хирургической аблации ФП при сопутствующем хирургическом лечении ИБС или клапанов сердца.…”