Concomitant surgical atrial fibrillation ablation and event recorder implantation: better monitoring, better outcome?

Pecha, Simon; Schäfer, T; Hartel, Friederike; Ahmadzade, T; Subbotina, Irina; Reichenspurner, Hermann; Wagner, Florian

doi:10.1093/icvts/ivs564

Cited by 12 publications

(6 citation statements)

References 12 publications

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“…[ 56 ] TAVR, and to a greater degree SAVR, carries a risk of developing NOAF. [ 57 , 58 ] This arrhythmia has significant health, economic, and clinical implications, because the length of hospital stay and the risk of stroke and mortality are increased. [ 59 ] Future studies identifying predictive factors for postprocedural NOAF will help in selecting high-risk patients who might benefit from prophylactic antiarrhythmic therapy or surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement

Ding¹,

Wan

Zhang³

et al. 2021

Medicine

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Background: Presently, transcatheter aortic valve replacement (TAVR) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, after surgical aortic valve replacement (SAVR) and TAVR, the incidence of new-onset atrial fibrillation (NOAF) is prevalently found. This meta-analysis was designed to comprehensively compare the incidence of NOAF at different times after TAVR and SAVR for patients with severe aortic disease. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVR and SAVR in the treatment of severe aortic disease. The primary outcomes were the incidence of NOAF with early, midterm and long term follow-up. The secondary outcomes included permanent pacemaker (PM) implantation, myocardial infarction (MI), cardiogenic shock, as well as mortality and other complications. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. Results: A total of 16 studies including 13,310 patients were identified. The pooled results indicated that, compared with SAVR, TAVR experienced a significantly lower incidence of 30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23–0.41; 5725 pts), 0.30 (95% CI 0.24–0.39; 6321 pts), 0.48 (95% CI 0.38–0.61; 3441 pts), and 0.45 (95% CI 0.37–0.55; 2268 pts) respectively. In addition, TAVR showed lower incidence of MI (RR 0.62; 95% CI 0.40–0.97) and cardiogenic shock (RR 0.34; 95% CI 0.19–0.59), but higher incidence of permanent PM (RR 3.16; 95% CI 1.61–6.21) and major vascular complications (RR 2.22; 95% CI 1.14–4.32) at 30-day/in-hospital. At 1- and 2-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of neurological events, transient ischemic attacks (TIA), permanent PM, and major vascular complications, respectively. At 5-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of TIA and re-intervention respectively. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVR and SAVR. Conclusions: Our analysis showed that TAVR was superior to SAVR in decreasing the both short and long term postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long term mortality. In addition, TAVR showed lower incidence of 30-day/in-hospital MI and cardiogenic shock after procedure. However, pooled results showed that TAVR was inferior to SAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications, and re-intervention.

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Section: Discussionmentioning

confidence: 99%

Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement

Ding¹,

Wan

Zhang³

et al. 2021

Medicine

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“…More intensive monitoring is associated with a greater likelihood of detecting both symptomatic and asymptomatic AF. 57 , 414 , 937 , 938 , 939 , 940 , 941 , 942 , 943 , 944 The proportion of asymptomatic compared with symptomatic events might be higher after AF ablation; two studies reported that the proportion of AF events that were asymptomatic was 11%–35% prior to and 53%–65% after ablation. 63 , 945 , 946 Another study reported that for patients in sinus rhythm, 53.8% of AF episodes were asymptomatic, with an increase in asymptomatic episodes changing from the acute to the chronic period after ablation, demonstrating that AF success cannot be based on the absence of symptoms alone.…”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…In one study after concomitant surgical ablation, ILRs compared with conventional Holter monitoring facilitated more follow-up antiarrhythmic management, including cardioversions and catheter ablation procedures, which were associated with a trend toward higher sinus rhythm rates at 1 year. 942 …”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

et al. 2017

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“…11 Some studies have used postoperative continuous monitoring, either invasive or noninvasive, to follow up patients. 12,13 Continuous monitoring allows a higher degree of confidence in detecting the real incidence of sinus rhythm recovery and occurrence of transient attacks of arrhythmias, compared to the interval monitoring used in our study. Unfortunately, such modalities of monitoring were not available in our center during our study.…”

Section: Discussionmentioning

confidence: 95%

Radiofrequency ablation of atrial fibrillation during mitral valve surgery

Oueida

Elawady

Eskander

2014

Asian Cardiovasc Thorac Ann

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Concomitant surgical atrial fibrillation ablation and event recorder implantation: better monitoring, better outcome?

Cited by 12 publications

References 12 publications

Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement

Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

Radiofrequency ablation of atrial fibrillation during mitral valve surgery

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