Stand Alone Surgical Ablation for Atrial Fibrillation

Abo-Salem, Elsayed; Paone, Ralph; Nugent, Kenneth; Perez‐Verdia, Alejandro; Deshpande, Alok; Amiri, Hoda Mojazi

doi:10.1111/jocs.12092

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…AF is common in the first month post STAF and this early recurrence is not clearly associated with long‐ term recurrence . The first 3 months after surgery is considered an observational blank period, such that AF recurrence in this period does not count toward procedure failures.…”

Section: Arrhythmia Recurrencementioning

confidence: 98%

“…The risk of AF recurrence decreases gradually over the next 3 months to a low level at 6 to 12 months . Another peak in recurrence may develop during the withdrawal of AAD …”

Section: Arrhythmia Recurrencementioning

confidence: 99%

“…The success rate may be lower with CMP III compared to CMPIV procedures, but there are no randomized trials comparing the 2 operations. Different surgical techniques with less extensive lesion sets have evolved into minimally invasive approaches that can be performed off pump through smaller incisions or thoracoscopically in selected cases without the need for concomitant open heart surgery (stand‐alone minimally invasive STAF, mini‐maze) …”

Section: Types Of Surgical Interventions In Afmentioning

confidence: 99%

“…According to the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the average mortality rate for stand‐alone STAF is 0.7% . Morbid obesity and obstructive sleep apnea are associated with an increased risk of postoperative respiratory adverse events . Operator experience is also an important determinant of outcomes.…”

Section: Complicationsmentioning

confidence: 99%

“…Postoperative sick sinus syndrome is the most common indication for a permanent pacemaker. It may resolve during long‐term follow‐up, but in 1 study 84% of the patients were still pacemaker dependent at one year of follow‐up . The primary predictor of need for a permanent pacemaker is right atrial ablations and older age.…”

Section: Complicationsmentioning

confidence: 99%

See 4 more Smart Citations

Surgical Treatment of Atrial Fibrillation

Abo-Salem

Lockwood

Boersma

et al. 2015

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common chronic arrhythmia in the adult population. Ablation lines have largely replaced the historical and challenging cut and sew techniques. Surgical ablation of AF is commonly performed in cases with other indications for cardiac surgery and less commonly as a stand-alone therapy. Pulmonary vein isolation is the cornerstone of this procedure. Extended left atrial ablation lines may increase efficacy in cases with longstanding persistent or permanent AF. Additional efficacy by adding right atrial ablation is controversial but is often performed in cases undergoing right atrial or atrial septal surgery. Left atrial volume reduction is recommended in cases with large left atria and AF undergoing another cardiac surgery. Arrhythmia recurrence is not uncommon after surgical ablation of AF and varies among studies due to heterogeneity in patient population, lesion set and endpoints. Freedom from AF recurrence was 65-87% at 12 months and 58-70% at 2 years follow-up. Long-term monitoring is recommended due to an increased prevalence of asymptomatic recurrences. The strongest predictors of AF recurrence are longstanding or persistent AF and a large left atrium. The most common mechanisms of recurrence are pulmonary vein reconnection, nonpulmonary vein triggers, and gaps in the ablation lines. About 20% of atrial tachyarrhythmia recurrences are atrial flutter or atrial tachycardia. There are not enough data in the surgical literature to support withdrawal of anticoagulation after surgical AF ablation. Patients selected for stand-alone surgical ablation usually have low risk profiles and low postoperative mortality rates (0.2%).

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Section: Arrhythmia Recurrencementioning

confidence: 98%

“…The risk of AF recurrence decreases gradually over the next 3 months to a low level at 6 to 12 months . Another peak in recurrence may develop during the withdrawal of AAD …”

Section: Arrhythmia Recurrencementioning

confidence: 99%

Section: Types Of Surgical Interventions In Afmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Surgical Treatment of Atrial Fibrillation

Abo-Salem

Lockwood

Boersma

et al. 2015

Cardiovasc electrophysiol

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Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications?

et al. 2017

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Úvod: Minimálně invazivní chirurgické ablace se stávají zajímavou možností, jak léčit pacienty s izolovanou fi brilací síní (FS). Obecně jsou však tyto ablace spojovány s vyšší četností perioperačních komplikací. Cílem této studie bylo shrnout výskyt komplikací u všech takových procedur provedených v našem centru a porovnat jej s údaji z relevantních publikací z poslední doby. Materiál a metody: Shromážděny a analyzovány byly veškeré údaje o všech perioperačních a 30denních komplikacích thorakoskopických ablací FS provedených v našem centru. V recentní literatuře byly vyhledány studie popisující výsledky thorakoskopických a hybridních ablací. Četnosti komplikací byly porovnány s naším souborem a také s četnostmi komplikací při katetrizačních ablacích FS. Výsledky: V letech 2006-2017 podstoupilo thorakoskopickou ablaci FS v našem centru celkem 112 pacientů, a to s využitím tří různých katétrů. Průměrný věk nemocných činil 61,4 ± 8,8 roku, z 66 % šlo o muže a z 53 % o pacienty s dlouhodobě perzistentní fi brilací síní. Život ohrožující komplikace se vyskytly u dvou (1,8 %) pacientů-šlo o jednu konverzi na sternotomii a jednu cévní mozkovou příhodu. Závažné komplikace postihly šest (5,4 %) pacientů, z nichž u dvou bylo nutno provést revizi pro krvácení, u tří došlo k rozvoji parézy bráničního nervu a u jednoho se vyvinulo respirační selhání. Méně či středně závažné komplikace se vyskytly u 17 (15,2 %) pacientů. V nedávné literatuře jsme nalezli 27 publikací (popisujících celkem 1 869 pacientů) vhodných pro srovnání s našimi výsledky. Četnosti život ohrožujících a závažných komplikací se v různých centrech pohybovaly od 0 % do 16 %, průměrná četnost dosahovala hodnoty 4,8 %. Pokud jde o studie zaměřené na katetrizační ablace FS, se závažnými komplikacemi po nich se setkáváme u 5-7 % nemocných. Závěry: Četnosti 30denních, život ohrožujících a závažných komplikací jsou u miniinvazivních chirurgických a katetrizačních ablací FS srovnatelné. Četnosti méně a středně závažných komplikací jsou vyšší po ablacích chirurgických. Aby výskyt komplikací zůstal nízký, či dokonce klesal, měly by chirurgické či hybridní výkony být prováděny ve specializovaných centrech s dostatečnými zkušenostmi.

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Stand Alone Surgical Ablation for Atrial Fibrillation

Abstract: Results with minimally invasive surgery are suboptimal at two years of follow-up, particularly for patients with persistent AF.

Cited by 8 publications

References 11 publications

Surgical Treatment of Atrial Fibrillation

Surgical Treatment of Atrial Fibrillation

Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications?

Alcohol ablation of the vein of Marshall in a patient with persistent atrial fibrillation and prior surgical ligation of the ligament of Marshall

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