Comparison of Uniatrial and Biatrial Radiofrequency Ablation Procedures in Atrial Fibrillation: Initial Results

Breda, João Roberto; Breda, Ana Silvia Castaldi Ragognetti; Ragognette, Ricardo Gitti; Machado, Leandro Neves; Neff, Charles Benjamin; Matos, Leandro Luongo de; Meneghine, Adriano; Pires, Ana Maria

doi:10.1532/hsf98.20101119

Cited by 9 publications

(21 citation statements)

References 15 publications

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“…In 10 studies (35.7%) mitral surgery was the main procedure performed in association with AF ablation, while in the remaining studies various types of main procedures (coronary surgery, valve surgery, aortic surgery, etc) were performed aside of AF ablation. Four studies enrolled only patients rheumatic valve disease (RVD) in both study groups, while 4 more studies reported a variable quota of RVD ranging between 50% and 70% of the population, while in the remaining 20 studies the incidence of RVD was not clearly stated.…”

Section: Resultsmentioning

confidence: 99%

“…23,35,36 Ten (35.7%) were prospective observational studies, of which two had propensity adjustment. 3,4,21,22,24,25,27,31,32,37 The remaining 15 studies (53.6%) were retrospective observational, of which 3 were propensity adjusted. 5,19,20,26,[28][29][30]33,34,38,39,[44][45][46][47] In 16 studies (57.1%) all the patients enrolled presented exclusively non-paroxysmal AF forms and these studies constituted the "non-paroxysmal AF subgroup."…”

Section: Discussionmentioning

confidence: 99%

“…5,19,20,26,[28][29][30]33,34,38,39,[44][45][46][47] In 16 studies (57.1%) all the patients enrolled presented exclusively non-paroxysmal AF forms and these studies constituted the "non-paroxysmal AF subgroup." [20][21][22][23][25][26][27][28][34][35][36][37][38][39]46,47 clearly specify the types of AF included. 5 As per protocol, no study with only paroxysmal AF patient was included.…”

Section: Discussionmentioning

confidence: 99%

“…In 10 studies (35.7%) mitral surgery was the main procedure performed in association with AF ablation, 19 Within studies adopting CM4, radiofrequency was the most common energy source used to perform the ablation: it was used in 11 studies (39.3%) as the only source of energy in both study groups, [21][22][23]25,26,34,35,37,44,45,47 while in 5 studies (17.8%) radiofrequency mainly used but it was complemented by cryoablation for some lesions. 19,20,24,30,36 These 16 studies were included in the Radiofrequency subgroup.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Ten studies (35.7%) 19,21,23,[25][26][27][28]32,36,46 The meta-analysis of safety and efficacy outcomes in this subgroup is presented in Abbreviations: BA, both atria; CI, confidence interval; LA, left atrial; WMD, weighted mean difference. characteristics in this subgroup, did not show any significant unbalancing between BA and LA patients characteristics, except the length of cardiopulmonary bypass (WMD 17.19 minutes, CI, 6.14-28.23 minutes, P = .002) and cross-clamp (WMD 7.68 minutes, CI = 1.31-14.04 minutes, P = .02) that were longer in the BA group (see Supplementary Material S4).…”

Section: Safety and Efficacy In The Mitral Subgroupmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Safety and Efficacy In The Mitral Subgroupmentioning

confidence: 99%

See 3 more Smart Citations

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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Role of an aggressive rhythm control strategy on sinus rhythm maintenance following intra-operative radiofrequency ablation of atrial fibrillation in patients undergoing surgical correction of valvular disease

Sponga

Leoni

Buja

et al. 2012

Journal of Cardiology

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Comparison of Left Atrial and Biatrial Maze Procedure in the Treatment of Atrial Fibrillation: A Meta-Analysis of Clinical Studies

Zheng

Zhang

et al. 2015

Thorac cardiovasc Surg

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The outcomes of atrial fibrillation (AF) between biatrial maze (BAM) and left atrial maze (LAM) are still controversial. The purpose of this study was to compare the clinical and rhythm outcomes between BAM and LAM in patients with AF. Electronic databases and article references were systematically searched (1990-2014) to access relevant studies. Odds ratio (OR) and weight mean difference (WMD) with 95% confidence interval (CI) were reported. Fourteen studies with 2,075 patients were finally involved in the present meta-analysis. The rate of restored sinus rhythm (SR) was similar in BAM and LAM groups (OR: 1.25, 95% CI: 0.91-1.72, = 0.163). BAM reduced the prevalence of atrial flutter during follow-up (OR: 0.12, 95% CI: 0.01-0.96, = 0.046). Compared with BAM, LAM shorten aortic cross-clamping time (WMD = 9.05 minutes, 95% CI: 1.28-16.82, = 0.023) and cardiopulmonary bypass time (WMD = 20.21 minutes, 95% CI: 7.40-33.03, = 0.002). No significant difference was found between groups in the risk of death (OR: 1.22, 95% CI: 0.70-2.14, = 0.233), cerebrovascular events (OR: 1.44, 95% CI: 0.51-4.06, = 0.493), and reoperation for bleeding (OR: 1.34, 95% CI: 0.70-2.55, = 0.374). However, the risk for implantation of permanent pacemaker was significantly higher in BAM group (OR: 2.60, 95% CI: 1.09-6.20, = 0.031). No significant difference was found between BAM and LAM in the rate of restored SR, the risk of death, cerebrovascular events, and reoperation for bleeding. BAM is superior to LAM in reducing the prevalence of atrial flutter during follow-up, but LAM shortens the aortic cross-clamping time and cardiopulmonary bypass time, and decreases the risk of permanent pacemaker implantation.

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Comparison of Uniatrial and Biatrial Radiofrequency Ablation Procedures in Atrial Fibrillation: Initial Results

Abstract: Biatrial ablation surgical procedures were more effective in controlling atrial fibrillation than procedures limited to the left atrium.

Cited by 9 publications

References 15 publications

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

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

Role of an aggressive rhythm control strategy on sinus rhythm maintenance following intra-operative radiofrequency ablation of atrial fibrillation in patients undergoing surgical correction of valvular disease

Comparison of Left Atrial and Biatrial Maze Procedure in the Treatment of Atrial Fibrillation: A Meta-Analysis of Clinical Studies

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