Surgical perspectives in the management of atrial fibrillation

Table 6 Summary of results from studies included looking at pulmonary vein isolation and left atrial appendage

Procedure	Ref.	Sample size	Mean follow-up period	Outcome	Important findiNGS
PVI	Haïssaguerre et al[9]	45 patients	8 ± 6 mo	Sinus rhythm achieved in 28 patients (62%)	69 foci identified as the source of ectopic atrial beats in 45 patients
PVI	Chao et al[21]	88 non-paroxysmal AF patients	36.8 mo	The long-term freedom period of AF was 28.4% after a single procedure	CHADS2 score of >/3 and left atrial diameter found to be significant predictors of recurrences
LAA obliteration	Healy et al[27]	RCT - 77 patients with risk factors for stroke	8 wk follow-up with trans-oesophageal echocardiography	Complete occlusion achieved in 45% (5/11) of patients through the use of sutures and in 72% (24/33) using a stapler	Surgical LAA can be safely done during a routine CABG; expertise is key to its success rates
LAA excision or exclusion	Kenderian et al[28]	137 patients	Post-operative trans-oesophageal echocardiography	Successful LAA closure 73% with surgical excision and 23% with suture exclusion. Evidence of stroke in 11% of successful LAA closure and 15% of unsuccessful LAA closure (P = 0.61)	High proportion of surgical LAA closure. LAA excision more successful than exclusion
LAA obliteration + Mitral valve replacement	García-Fernández et al[29]	58 patients	69.4 mo trans-oesophageal echocardiography	46% of patients had an embolism. Risk of embolism increased by 11.6 in incomplete/absence of LAA ligation	Absence of LAA ligation and presence of left atrial thrombus identified as independent predictors for stroke
LAA exclusion during mitral valve surgery	Almahameed et al[30]	136 patients	3.6 ± 1.3 yr	12.3% of patients had thromboembolic events, 71% of which occurred in patients undergoing mitral valve repair	There were more thromboembolic events in patients not prescribed warfarin on discharge

PVI: Pulmonary vein isolation; LAA: Left atrial appendage.