Surgical ablation of atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials

McClure, Ghyslaine; Belley‐Côté, Emilie P.; Jaffer, Iqbal H.; Dvirnik, Nazari; An, Kevin R.; Fortin, Gabriel; Spence, Jessica; Healey, Jeff S.; Singal, Rohit K.; Whitlock, Richard

doi:10.1093/europace/eux336

Cited by 67 publications

(62 citation statements)

References 38 publications

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“…In RF ablation cases, 70% of operators used clamp probes, 20% used pen probes, and 10% used both probes. There is an observed 56% biatrial: 44% unilateral ablation rate in ongoing LAAOS III trial (NCT01561651), and an incremental pacemaker implantation rate of approximately 3.26% (85% DDD, 15% VVI) based on industry expert input and both published 5 and unpublished event rates.…”

Section: Resultsmentioning

confidence: 99%

“…An updated systematic review and meta‐analysis of 23 randomized controlled trials (RCTs) demonstrated that the evidence regarding surgical ablation is of moderate quality and found no significant difference in clinical outcomes including mortality and stroke in patients who underwent concomitant surgical ablation of AF compared with those who did not 5 . Improved maintenance of sinus rhythm is the only observed benefit thus far, while patients undergoing this procedure experience longer lengths‐of‐stay and, in the case of biatrial procedures, a nearly three‐fold increase in the risk of permanent pacemaker (PPM) implantation 5 . Concomitant surgical ablation of AF during cardiac surgery incurs additional costs, which have not yet been described in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Costs of surgical ablation of atrial fibrillation in Ontario, Canada from 2006 to 2017

et al. 2020

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Background: International guidelines currently recommend concomitant surgical ablation of atrial fibrillation (AF) in patients with AF undergoing cardiac surgery. However, a systematic review and meta-analysis of 23 randomized controlled trials (RCTs) showed no significant difference in mortality or stroke in patients who underwent surgical AF ablation compared with those who did not (moderate-quality evidence). Methods: We estimated the Ontario-wide costs of surgical AF ablation between 2006 and 2017 using data from a systematic review and meta-analysis of RCTs, estimates of case volumes from Ontario Health Insurance Plan fee codes, the ongoing left atrial appendage occlusion study III trial (NCT01561651), institutional costs from large academic centers in Ontario, as well as professional fees based on the Ontario fee schedule. Device costs were obtained from Canadian industry data with expert input. Results: We estimated the average extra cost of surgical AF ablation at $4,287 CAD (95% CI $4,113-4,619) per patient. Procedural costs (equipment costs and physician remuneration) comprise 82.2% of this, while smaller portions relate to the increased need for pacemaker (3.9%) and additional hospital length of stay (13.9%). Approximately 2,391 patients underwent surgical AF ablation between 2006 and 2017, corresponding to an estimated $10.2 million in incremental cost during that time span. Conclusion: Ontario taxpayers spend significant financial resources on surgical ablation of AF, a procedure lacking high-quality evidence demonstrating benefit in reducing mortality or stroke. Further large prospective studies examining clinically important outcomes are needed to justify its routine use in patient care and to guide allocation of healthcare funds.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Costs of surgical ablation of atrial fibrillation in Ontario, Canada from 2006 to 2017

et al. 2020

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“…The relationship is unclear, large meta-analyses comparing PPM insertion rates have demonstrated no significant increase in post-operative PPM requirement during concomitant AF ablation [48], yet a Cochrane review has demonstrated an increased requirement [47]. There is a presumed association between RA lesions and PPM implantation, and indeed a recent meta-analysis demonstrated that bi-atrial AF ablation surgery was associated with increased PPM insertion compared to isolated LA ablation [71]. Although not universal, most clinical studies show the increased need for PPM after AF ablation surgery to be driven mainly by sick sinus syndrome [9].…”

Section: Complications Of Atrial Fibrillation Surgerymentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation

Navaratnarajah¹,

Luthra²,

Ohri³

2020

Epidemiology and Treatment of Atrial Fibrillation

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The concepts, techniques and evidence relating to surgical ablation of atrial fibrillation are discussed in detail. The historical background to surgical ablation is covered in brief, along with the electrophysiological basis underpinning its effective useage. The epidemiology of surgically treated atrial fibrillation and the current guidelines relating to its use are analysed. Safety aspects and perspectives on its ongoing future use are discussed. Modern surgical technologies and approaches are reviewed, along with the relevant advantages and disadvantages of each. The surgical techniques relating to left atrial appendage intervention are also reviewed, along with the relevant literature and evidence relating to reduction in thromboembolic risk and need for anticoagulation.

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“…Так, например, в одном большом метаанализе, куда были включены 23 рандомизированных клинических исследования, хирургическая БА продемонстрировала более высокую эффективность во время операции на сердце по сравнению с ЛА [49]. Однако различия в важных для пациента показателях, включая смертность и частоту инсультов, не имели статистической значимости.…”

Section: сравнение двух методик -аблации изолированного левого предсеunclassified

“…Данные этих исследований оказались недостоверны для обнаружения какого-либо влияния выбранного метода на важные события, такие как смерть, тромбоэмболические или нейроваскулярные осложнения. При этом результаты свидетельствуют о повышенном риске имплантации кардиостимуляторов в период наблюдения после операции «Лабиринт» и БА по сравнению с изолированной ЛА [49]. В работе S. Miyazaki et al были получены 5-летние отдаленные послеоперационные результаты у пациентов с постоянной формой ФП [57].…”

Section: сравнение двух методик -аблации изолированного левого предсеunclassified

Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

Калыбекова¹,

Chernyavskiy²

2019

AnnAritmol

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Among patients with coronary heart disease or acquired heart valvular disease requiring surgical treatment, the prevalence of atrial fibrillation (AF) is up to 85%. The presence of concomitant atrial fibrillation increases the risk of postoperative complications, including fatal ones, worsens the prognosis of postoperative survival and the quality of life of patients. Surgical ablation in AF significantly prolongs the maintenance of sinus rhythm and is recommended as a concomitant procedure in patients requiring surgical correction of an open heart. To date, there is no single method for the surgical treatment of AF in the open heart surgery. Patients with ischemic heart disease or mitral valvular disease and concomitant AF are recommended for open heart ablation. Much research has been devoted to the ablation of two atria at once, which have shown their effectiveness in comparison with the ablation of an isolated left atrium, including the safety of the method of twoatrial surgical ablation. We conducted a systematic review based on meta-analyzes, randomized clinical trials, including comparative characteristics of two surgical treatments for AF in concomitant cardiovascular diseases such as coronary artery disease and acquired heart disease. The main purpose of this review was to compare two methods (biatrial and left atrial) of ablation, as a concomitant surgical procedure for open heart surgery in patients with coronary heart disease and acquired heart disease, complicated by long-term persistent atrial fibrillation. We used PubMed, Cochrane central, Publons, and Medline search systems from March to September 2019, evaluating surgical ablation of AF, including biatrial or isolated left atrial ablation on patients requiring and going for open heart surgery. Surgical ablation of AF combined with concomitant open heart surgery has showed excellent results, where freedom from atrial fibrillation in the long-term postoperative period was noted. Among surgical ablation techniques, biatrial ablation was more effective than left atrial, although the frequency of permanent pacemaker implantation was higher in the biatrial ablation group. In most studies, endpoints important to the patient, including mortality and stroke, did not differ in both groups.

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Surgical ablation of atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials

Cited by 67 publications

References 38 publications

Costs of surgical ablation of atrial fibrillation in Ontario, Canada from 2006 to 2017

Costs of surgical ablation of atrial fibrillation in Ontario, Canada from 2006 to 2017

Surgical Treatment of Atrial Fibrillation

Comparative characteristics of biatrial and left atrial ablation in surgical treatment of long-standing persistant atrial fibrillation in patients with concomitant disease

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