Guideline for the surgical treatment of atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is ∼1-2% of the general population, but higher with increasing age and in patients with concomitant heart disease. The Cox-maze III procedure was a groundbreaking development and remains the surgical intervention with the highest cure rate, but due to its technical difficulty alternative techniques have been developed to create the lesions sets. The field is fast moving and there are now multiple energy sources, multiple potential lesion sets and even multiple guidelines addressing the issues surrounding the surgical treatment of AF both for patients undergoing this concomitantly with other cardiac surgical procedures and also as stand-alone procedures either via sternotomy or via videothoracoscopic techniques. The aim of this document is to bring together all major guidelines in this area into one resource for clinicians interested in surgery for AF. Where we felt that guidance was lacking, we also reviewed the evidence and provided summaries in those areas. We conclude that AF surgery is an effective intervention for patients with all types of AF undergoing concomitant cardiac surgery to reduce the incidence of AF, as demonstrated in multiple randomized studies. There is some evidence that this translates into reduced stroke risk, reduced heart failure risk and longer survival. In addition, symptomatic patients with AF may be considered for surgery after failed catheter intervention or even as an alternative to catheter intervention where either catheter ablation is contraindicated or by patient choice.

Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

“…20 These potential advantages notwithstanding, the LAA was not routinely addressed in the patients treated in center 3 and in a subgroup of the patients treated in center 2 to maintain LA contractility and prevent possible hydroelectrolytic unbalances. 21 This policy did not influence the primary endpoint or incidence of adverse events, although it resulted in a higher percentage of patients on oral anticoagulants. When regarding future cardiac interventions, thoracoscopically entering the pericardium may leave some adhesions, but it does not exclude the possibility for later cardiac interventions through median sternotomy.…”

Biatrial ablation versus limited right atrial ablation for atrial fibrillation associated with atrial septal defect in adults

“…concomitant surgical aF radiofrequency ablation is recognized as an effective way to eliminate aF for patients with aF and structural heart disease [6,7,11]. However, it remains unclear whether biatrial ablation is more effective and safer than limited left or right atrial ablation [8-10, 12, 13].…”

“…The Maze procedure is used widely in clinical practice and recognized as the most effective method to cure aF, but it is complex and difficult [4,5]. Surgical radiofrequency (rF) ablation has emerged as another effective treatment for aF associated with cHD [6,7]. now, either limited right atrial or biatrial rF ablation is used to treat aF associated with aSD, but it remains controversial whether biatrial rF ablation is superior to limited right atrial rF ablation for persistent or long-standing persistent aF associated with aSD [8][9][10].…”

Posterior pericardiotomy in cardiac surgery: systematic review and meta-analysis

“…Quality assessment of randomized controlled trials was performed using the Jadad score. 7 The Jadad score assesses 3 items including randomization (0-2 points), blinding of study (0-2 points), and withdrawals and dropouts (0-1 points). Higher scores indicate better reporting (high quality ¼ 5; good quality ¼ 3-4; poor quality ¼ 0-2).…”