Event Recorder Monitoring to Compare the Efficacy of a Left Versus Biatrial Lesion Set in Patients Undergoing Concomitant Surgical Ablation for Atrial Fibrillation

Pecha, Simon; Hartel, Friederike; Ahmadzade, T; Alassar, Y.; Deuse, T.; Aydin, Ali; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian

doi:10.1055/s-0035-1544306

Cited by 3 publications

(9 citation statements)

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“…Ten (35.7%) were prospective observational studies, of which two had propensity adjustment . The remaining 15 studies (53.6%) were retrospective observational, of which 3 were propensity adjusted …”

Section: Resultsmentioning

confidence: 99%

“…In 16 studies (57.1%) all the patients enrolled presented exclusively non‐paroxysmal AF forms and these studies constituted the “non‐paroxysmal AF subgroup.” Instead Eleven (39.3%) studies included both patients with paroxysmal and non‐paroxysmal AF forms while only one study did not clearly specify the types of AF included . As per protocol, no study with only paroxysmal AF patient was included.…”

Section: Resultsmentioning

confidence: 99%

“…The non‐paroxysmal AF subgroup was composed of 16 studies (57.1%) not enrolling patients with paroxysmal AF. The comparison of preoperative and intraoperative 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: Resultsmentioning

confidence: 99%

“…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." [20][21][22][23][25][26][27][28][34][35][36][37][38][39]46,47 clearly specify the types of AF included.…”

Section: Discussionmentioning

confidence: 99%

“…Discrepancies between reviewers were resolved by group discussion. At this stage, 7392 articles were excluded because they did not match study criteria while 37 articles were reviewed at full‐text level. The references of these articles were screened and 8 more articles were identified reaching 45 articles assessed at full‐text level: of these, 17 were excluded for the following reasons: (a) despite reporting the use of BA and LA approaches in 8 studies there was no clear separation of at least one outcome for the two groups, only one type (BA or LA) of ablation approach reported for 6 studies, patients populations overlapping with studies already included for 3 studies, leaving in total 28 studies suitable to be included in this meta‐analysis …”

Section: Methodsmentioning

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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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Commentary: Do teach old dogs new tricks

Sternik

2022

The Journal of Thoracic and Cardiovascular Surgery

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Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

Ali¹,

Lambert²,

Carrier³

et al. 2015

Clin Med Rev Case Rep

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emerged to surgically treat AF [6]. Controversies exist, considering the ideal lesion pattern, regarding the necessity to add right atrial lesions or not to the left atrial lesions. Biatrial lesions have never been compared head to head in a randomized fashion with left atrial maze before the paper of Gilinov for the CTSN investigators [7]. Furthermore, there is a lack of standardization in reporting postoperative results. Most reports indicated the incidence of sinus rhythm on a spot Electrocardiogram (ECG) or 24-hours of continuous cardiac monitoring (CCM) performed at the time a follow-up visit. The use of a reliable technique for continuous monitoring of heart rhythm for over a year postoperatively would allow a more careful evaluation of how prevalent are subclinical forms of atrial fibrillation recurrences [8]. We design this study to evaluate the pattern of recurrence of atrial fibrillation and the AF burden 1 year following mitral surgery comparing the effect of biatrial lesions and left atrial lesions using a continuous monitoring device. Materials and methods This study was approved by the local ethics committee/review board. Informed consent was obtained of each patient. The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. Design of study From January 2011 to December 2012, we prospectively screened all patients planned for mitral valve surgery from degenerative or rheumatic etiology combined or not to Coronary Artery Bypass Graft (CABG) or tricuspid repair. Patients with severe left ventricular dysfunction, complex congenital anomaly, concomitant aortic valve replacement or planned mitral surgery too complex to attempt a biatrial lesion were excluded from the study. All patients with paroxysmal or continuous atrial fibrillation from chart based on ECG or a sinus rhythm with documented atrial size above 45mm on preoperative echocardiogram were selected and allocated into 3 groups regarding their rhythm. All patients were operated by the same surgeon. Patients of each group were randomized to receive left atrial lesion or biatrial lesion or not receive a concomitant AF ablation at time of mitral surgery. Radio frequency ablation procedure AF ablation was achieved through a sternotomy when the mitral

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Event Recorder Monitoring to Compare the Efficacy of a Left Versus Biatrial Lesion Set in Patients Undergoing Concomitant Surgical Ablation for Atrial Fibrillation

Cited by 3 publications

References 0 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

Commentary: Do teach old dogs new tricks

Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

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