Epicardial off-pump pulmonary vein isolation and vagal denervation improve long-term outcome and quality of life in patients with atrial fibrillation

Bagge, Louise; Blomström, Per; Nilsson, Leif; Einarsson, Gunnar Myrdal; Jidéus, Lena; Blomström‐Lundqvist, Carina

doi:10.1016/j.jtcvs.2008.12.017

Cited by 55 publications

(62 citation statements)

References 18 publications

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“…4) Factors related to the development of permanent AF have been reported. 2,[5][6][7] A number of recent studies 3,[8][9][10][11] have associated AF and its treatment with quality-of-life issues.…”

Section: Discussionmentioning

confidence: 99%

Symptoms of Atrial Fibrillation in Patients With and Without Subsequent Permanent Atrial Fibrillation Based on a Retrospective Questionnaire Survey

Kawara¹,

Narumi

Hirao

et al. 2010

Int. Heart J.

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SummaryThe aim of the present study was to determine whether symptoms of atrial fibrillation (AF) differ between patients with and without subsequent permanent AF. Sixty-four patients (68 ± 10 years old, 45 males) were recruited. AF followup was started at the age of 61 ± 10 years and accomplished in a median period of 4.9 years (396 person-years). Permanent AF, defined as lasting > 180 days, developed in 17 patients (14 males) (43 per 1000 person-years). The AF followup period was longer in the permanent AF group than in the non-permanent AF group (median, 9.8 versus 4.2 years, P < 0.001). For baseline characteristics, hypertension was less frequent in the permanent AF group than in the nonpermanent AF group (18% versus 45%, P < 0.05). A retrospective questionnaire survey regarding initial AF symptoms was conducted. The severity of AF symptoms by a 4-grade scale was significantly milder in the permanent AF group than in the nonpermanent AF group (P < 0.05). Cox proportional hazards model analysis revealed that the severity of initial AF symptoms was related to the subsequent development of permanent AF (hazard ratio 0.46 per grade, 95% confidence interval 0.23 -0.93, P < 0.05), but age, gender, hypertension, diabetes mellitus, organic heart disease, and left atrial dimension were not. The permanent AF-free rate was significantly lower in 33 patients with mild symptoms than in 31 patients with severe symptoms (log-rank test, P < 0.05). These results point to an inconspicuous feature in the development of permanent AF. (Int Heart J 2010; 51: 242-246) Key words: Arrhythmia, Heart failure, Hypertension, Susceptibility T he severity of symptoms is quite an important factor for determining the prognosis of patients with organic heart disease. The New York Heart Association classification of cardiac performance is clearly related to subsequent cardiac events. Syncope is a risk factor for sudden cardiac death in patients with a Brugada-type electrocardiogram. As a consequence, symptoms affect the treatment of such diseases. Atrial fibrillation (AF) causes variable symptoms, from mild which are subclinical, to severe requiring emergency care. Very slightly symptomatic AF is allowed and left; by contrast, severely symptomatic AF requires intensive therapies to restore or maintain sinus rhythm. AF usually occurs in a paroxysmal or persistent form, and then develops into a permanent form when the feasibility of restoring sinus rhythm becomes extremely low.1,2) We believe that patients' perceptions of their symptoms may be associated with the course of AF. To clarify whether the symptoms of AF differ between patients with and without subsequent development of permanent AF, a retrospective questionnaire survey was carried out. MethodsEthical issues: The study was conducted in accordance with Good Clinical Practice guidelines and the Declaration of Helsinki. The study protocol and written subject information were reviewed and approved by the ethics committee of Tokyo Medical and Dental University. Sixty-four patients (68 ±...

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Section: Discussionmentioning

confidence: 99%

Symptoms of Atrial Fibrillation in Patients With and Without Subsequent Permanent Atrial Fibrillation Based on a Retrospective Questionnaire Survey

Kawara¹,

Narumi

Hirao

et al. 2010

Int. Heart J.

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“…10 Several single-center studies reported overall 1-year freedom from AF between 62% and 80%. 7,[11][12][13] The longest follow-up was reported by Hu and colleagues. 6 Their single-center study enrolled 78 patients who had undergone 5-year follow-up;…”

Section: Recurrence Of Atasmentioning

confidence: 99%

“…6,[11][12][13]25 Finally, we used 2D echocardiography to assess LA function. Other types of measurements, such as 3D echocardiography, computed tomographic scanning, and cardiac magnetic resonance imaging, might be more accurate.…”

Section: Study Limitationsmentioning

confidence: 99%

Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

Zhu

et al. 2018

Clinical Cardiology

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BackgroundOur previous study reported a modified endoscopic procedure for nonvalvular atrial fibrillation (AF) that requires only 3 ports in the left chest wall.HypothesisCertain preoperative variables might be predictive risk factors for AF recurrence among patients who underwent this procedure.MethodsFrom October 2010 to April 2014, 114 patients with either paroxysmal AF (PAF) or nonparoxysmal AF (non‐PAF) underwent the procedure and completed postoperative cardiac‐rhythm measurement via electrocardiography and Holter monitoring. Univariate and multivariate analyses of the possible AF‐related risk factors were conducted.ResultsDuring 2‐year follow‐up, 99 of 114 patients (86.8%) were free from atrial tachyarrhythmia. Results from univariate analyses showed that AF duration, left atrial diameter (LAD), left atrial minimum volume, left atrial empty fraction, left atrial expansion index, and left atrial active empty fraction (LAAEF) were significantly associated with postoperative AF recurrence. Results from multivariate analyses showed that AF duration (odds ratio [OR]: 1.194, 95% CI: 1.063‐1.340, P = 0.003), LAD (OR: 1.101, 95% CI: 1.005‐1.205, P = 0.039), and LAAEF (OR: 0.490, 95% CI: 0.277‐0.865, P = 0.014) were independent risk factors. There was no difference in AF recurrence between patients with PAF and non‐PAF (P = 0.250).ConclusionsOur 2‐year follow‐up study suggested that low LAAEF, long AF duration, and large LAD might be potential predictive risk factors for AF recurrence. Patients with PAF and non‐PAF had a similar AF recurrence rate after modified endoscopic ablation.

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“…3 Although numerous series are available in the literature, 21–25 only 6 conform to modern standards ( Tables 1,2 ). 26–31 The smaller single-center studies (n=20–52) report overall 1-year freedom from ATAs between 65% and 81%, but success decreases to 51–75% when freedom from AADs is also considered ( Table 2 ). 26,28–30 Those studies are all comparable in terms of the lesion sets that were performed, with the notable exception that McClelland et al 30 did not perform LAA exclusion/excision ( Table 1 ).…”

Section: Pv Isolation (Pvi)mentioning

confidence: 99%

“…26–31 The smaller single-center studies (n=20–52) report overall 1-year freedom from ATAs between 65% and 81%, but success decreases to 51–75% when freedom from AADs is also considered ( Table 2 ). 26,28–30 Those studies are all comparable in terms of the lesion sets that were performed, with the notable exception that McClelland et al 30 did not perform LAA exclusion/excision ( Table 1 ). It is important to note that the majority of reported patients had PAF, and LA sizes were relatively small, with averages in the low to mid 4 cm range ( Table 2 ).…”

Section: Pv Isolation (Pvi)mentioning

confidence: 99%

Surgical Techniques Used for the Treatment of Atrial Fibrillation

Robertson

Lawrance

Maniar

et al. 2013

Circ J

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The use of surgical lesion sets for the treatment of atrial fibrillation has been increasing, particularly in patients with complicated anatomical substrates and those undergoing concomitant surgery. Preferences in terms of lesion set, surgical approach and ablation technology vary by center. This review discusses both the surgical techniques and the outcomes for the most commonly performed procedures in the context of recent consensus guidelines. The Cox-Maze IV, pulmonary vein isolation, extended left atrial lesion sets, the hybrid approach and ganglionated plexus ablation are each reviewed in an attempt to provide insight into current clinical practice and patient selection

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Epicardial off-pump pulmonary vein isolation and vagal denervation improve long-term outcome and quality of life in patients with atrial fibrillation

Cited by 55 publications

References 18 publications

Symptoms of Atrial Fibrillation in Patients With and Without Subsequent Permanent Atrial Fibrillation Based on a Retrospective Questionnaire Survey

Symptoms of Atrial Fibrillation in Patients With and Without Subsequent Permanent Atrial Fibrillation Based on a Retrospective Questionnaire Survey

Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

Surgical Techniques Used for the Treatment of Atrial Fibrillation

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