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1
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Sunder T, Ramesh P, Kumar M. Atrial arrhythmias following lung transplantation: A state of the art review. World J Transplant 2025; 15:101005. [DOI: 10.5500/wjt.v15.i2.101005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 10/25/2024] [Accepted: 11/19/2024] [Indexed: 02/21/2025] Open
Abstract
Lung transplantation (LT) is now an accepted therapy for end stage lung disease in appropriate patients. Atrial arrhythmias (AA) can occur after LT. Early AA after LT are most often atrial fibrillation, whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia. The causes of AA are multifactorial. The review begins with a brief history of LT and AA. This review further describes the pathophysiology of the AA. The risk factors, incidence, recipient characteristics including intra-operative factors are elaborated on. Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT, the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia. The strategy of rate control vs rhythm control is discussed. The pros and cons of various drug regimen, need for direct current cardioversion and catheter ablation therapies are considered. Possible methods to prevent or reduce the incidence of AA after LT are considered. The impact of AA on the short-term and long-term outcomes following LT is discussed.
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Affiliation(s)
- Thirugnanasambandan Sunder
- Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
| | - Paul Ramesh
- Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
| | - Madhan Kumar
- Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
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Evtushenko A, Evtushenko V, Gusakova A, Suslova T, Varlamova Y, Zavadovskiy K, Lebedev D, Kutikhin A, Pavlyukova E, Mamchur S. Neurohumoral Markers of Cardiac Autonomic Denervation after Surgical Ablation of Long-Standing Persistent Atrial Fibrillation. Life (Basel) 2023; 13:1340. [PMID: 37374123 PMCID: PMC10300786 DOI: 10.3390/life13061340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Although the autonomic nervous system has an evident impact on cardiac electrophysiology and radiofrequency ablation (RFA) is the conventional technique for treating persistent atrial fibrillation, the specific effects of RFA have been insufficiently studied to date. Here, we investigated whether RFA affects neurohumoral transmitter levels and myocardial 123I-metaiodobenzylguanidine (123I-MIBG) uptake. To perform this task, we compared two groups of patients with acquired valvular heart disease: patients who had undergone surgical AF ablation and patients with sinus rhythm. The decrease in norepinephrine (NE) level in the coronary sinus had a direct association with the heart-to-mediastinum ratio (p = 0.02) and a negative correlation with 123I-MIBG uptake defects (p = 0.01). The NE level decreased significantly after the main surgery, both in patients with AF (p = 0.0098) and sinus rhythm (p = 0.0039). Furthermore, the intraoperative difference between the norepinephrine levels in the ascending aorta and coronary sinus (ΔNE) of -400 pg/mL was determined as a cut-off value to evaluate RFA efficacy, as denervation failed in all patients with ΔNE < -400 pg/mL. Hence, ΔNE can be utilized to predict the efficacy of the "MAZE-IV" procedure and to assess the risk of AF recurrence after RFA.
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Affiliation(s)
- Alexey Evtushenko
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Vladimir Evtushenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Anna Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Tatiana Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Yulia Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Konstantin Zavadovskiy
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Denis Lebedev
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Anton Kutikhin
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Elena Pavlyukova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Sergey Mamchur
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
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Onorati F, Francica A, Tonelli F, Luciani GB. Convergent procedure for non-paroxysmal atrial fibrillation: a light in the darkness. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6873740. [PMID: 36469334 DOI: 10.1093/ejcts/ezac556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Filippo Tonelli
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
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Zheng Z, Li H, Liu S, Gao G, Yu C, Lin H, Meng Y. Box lesion or bi-atrial lesion set for atrial fibrillation during thoracoscopic epicardial ablation. Interact Cardiovasc Thorac Surg 2022; 34:1-8. [PMID: 34999802 PMCID: PMC8923398 DOI: 10.1093/icvts/ivab211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/27/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Thoracoscopic epicardial ablation with a limited lesion set led to suboptimal results for advanced paroxysmal atrial fibrillation (AF) or persistent AF. Whether additional right atrial lesions improve the result is unclear. METHODS We conducted a retrospective study involving 80 consecutive patients with paroxysmal or persistent AF, left atrial (LA) dilation (LA diameter >40 mm) and failed prior interventional ablation (40 patients, 50%) who underwent thoracoscopic epicardial ablation with box lesions (36 patients) or bi-atrial (BA) lesion (44 patients) in our institution. Freedom from atrial tachyarrhythmias after the procedures was compared between the box lesion group and BA lesion group. RESULTS Baseline differences included more patients with persistent AF (86.4% vs 47.2%) and larger left atrium [48.00 (44.00-50.75) vs 42.00 (41.25-44.00) mm] in the BA lesion group. There was no difference in procedural complications between the 2 groups. After a mean follow-up of 32 months, the freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 6, 12 and 24 months was 77.2%, 77.2% and 77.2% in the BA lesion group and 69.4%, 50.0% and 40.6% in the box lesion group, respectively (P = 0.006). After adjustment for sex, age, body mass index, LA diameter, AF type, history of AF, and previous interventional ablation, BA lesion was an independent predictor of lower atrial tachyarrhythmia recurrence (hazard ratio 0.447, 95% confidential interval 0.208-0.963; P = 0.040). CONCLUSIONS Compared with the box lesion set, thoracoscopic epicardial ablation with BA lesion sets might provide better freedom from atrial tachyarrhythmias for paroxysmal or persistent AF with LA dilation. Randomized control trials are warranted to confirm the benefit of BA lesion sets in these patients.
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Affiliation(s)
- Zhe Zheng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Liu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunyu Yu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengqiang Lin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Meng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Yu C, Li H, Zhang H, Zheng Z. Midterm results of stand-alone thoracoscopic epicardial ablation with box lesion for atrial fibrillation. Interact Cardiovasc Thorac Surg 2021; 33:354-361. [PMID: 34160047 DOI: 10.1093/icvts/ivab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The short-term results of video-assisted thoracoscopic surgical ablation (VTSA) with box lesion have been highly variable, and the actual efficacy requires clarification through longer follow-ups. We aimed to report which patients might benefit more from VTSA with box lesion by longer follow-up. METHODS From September 2010 to November 2016, patients with atrial fibrillation (AF) who underwent VTSA with box lesion were screened. All enrolled patients visited the outpatient clinic and underwent 24-h Holter monitoring at 3, 6 and 12 months after surgery and annually thereafter. RESULTS A total of 91 consecutive patients [age, 58.0 (interquartile interval from 52.0 to 62.0) years; male, 71.4%] with paroxysmal (67%) or persistent/long-standing persistent (33%) AF were enrolled. After a median follow-up of 48 months (interquartile interval from 36 to 60 months), freedom from atrial tachyarrhythmias without antiarrhythmic drugs (AADs) was 76.5%, 66.0% and 66.0% for paroxysmal AF and 58.6%, 47.8% and 34.2% for persistent/long-standing persistent AF at 12, 36 and 60 months, respectively (P = 0.017). The preoperative left atrial diameter >40 mm (hazard ratio: 2.837, 95% confidence interval: 1.408-5.716; P = 0.004) and age >50 years (hazard ratio: 2.927, 95% confidence interval: 1.359-6.305; P = 0.006) were associated with recurrences of atrial tachyarrhythmias. In patients with paroxysmal AF and left atrial diameter ≤40 mm (n = 43), freedom from atrial tachyarrhythmias without AADs was 81.4%, 74.3% and 74.3% at 12, 36 and 60 months, respectively. CONCLUSIONS In patients with paroxysmal AF and left atrial diameter ≤40 mm, 5-year freedom from atrial tachyarrhythmias without AADs was 74.3%, which was better than that in patients with left atrial diameter >40 mm. A larger sample size and improved study design are needed to confirm our conclusions.
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Affiliation(s)
- Chunyu Yu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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Cox JL, Churyla A, Kislitsina ON, Chris Malaisrie S, McCarthy PM. Cardiac anatomy pertinent to the catheter and surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2118-2127. [PMID: 32162761 DOI: 10.1111/jce.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 12/28/2022]
Abstract
In the 1980s when surgery was first introduced for the treatment of atrial fibrillation (AF), one would often hear comments like "Every little old grandmother has AF. Why on earth would you operate on someone like that?".
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Affiliation(s)
- James L Cox
- Divisions of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Andrei Churyla
- Divisions of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Olga N Kislitsina
- Divisions of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois.,Divisions of Cardiology, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - S Chris Malaisrie
- Divisions of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Patrick M McCarthy
- Divisions of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
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7
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Boll G, Rowin EJ, Maron BJ, Wang W, Rastegar H, Maron MS. Efficacy of Combined Cox-Maze IV and Ventricular Septal Myectomy for Treatment of Atrial Fibrillation in Patients With Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2020; 125:120-126. [PMID: 31727261 DOI: 10.1016/j.amjcard.2019.09.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation (AF) has important clinical consequences in hypertrophic cardiomyopathy (HC). Safety and efficacy of the Cox-Maze IV procedure (when combined with ventricular septal myectomy) in patients with obstructive HC and paroxysmal AF is largely unresolved. Records of 395 consecutive HC patients (age 55 ± 13 years) who underwent septal myectomy for heart failure symptoms between 2004 and 2015 were reviewed. Sixty-two patients also had concomitant complete biatrial Cox-Maze IV for a history of symptomatic paroxysmal AF (3.0 ± 3.6 episodes) combined with myectomy comprise the study cohort. Freedom from symptomatic AF recurrences after operation was assessed. Left ventricular outflow gradients were reduced from 81 ± 28 mm Hg preoperatively to 1.2 ± 6.8 mm Hg after operation. At most recent follow-up, 53 patients (85%) were asymptomatic or mildly symptomatic. Freedom from recurrent symptomatic AF after myectomy/Cox-Maze IV was: 85% (95% confidence interval [CI] 73, 92) at 1 year, 69% (95% CI 55, 79) at 3 years, and 64% (95% CI 48, 75) at 5 years, including 34 patients (54%) who have experienced no symptomatic AF episodes for up to 8.2 years following surgery. The only clinical predictor of recurrent AF over follow-up was preoperative transverse left atrial dimension ≥45 mm (p <0.01). In conclusion, biatrial Cox-Maze IV combined with septal myectomy is associated with favorable long-term freedom from symptomatic paroxysmal AF recurrence, as well as from obstructive heart failure symptoms. These data support myectomy/Cox-Maze as an effective management option for the subgroup of HC patients with symptomatic outflow obstruction and paroxysmal AF.
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8
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Haldar SK, Jones DG, Khan H, Panikker S, Jarman JWE, Butcher C, Lim E, Wynn G, Gupta D, Hussain W, Markides V, Wong T. Characterising the difference in electrophysiological substrate and outcomes between heart failure and non-heart failure patients with persistent atrial fibrillation. Europace 2018; 20:451-458. [PMID: 28108547 DOI: 10.1093/europace/euw380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/26/2016] [Indexed: 12/24/2022] Open
Abstract
Aims Characterizing the differences in substrate and clinical outcome between heart failure (HF) and non-heart failure (non-HF) patients undergoing persistent atrial fibrillation (AF) ablation. Methods and results Using complex fractionated electrograms (CFE) as a surrogate marker of substrate complexity, we compared the bi-atrial substrate in patients with persistent AF with and without HF, at baseline and after ablation, to determine its impact on clinical outcome. In this retrospective analysis of two prospective studies, 60 patients underwent de-novo step-wise left atrial (LA) ablation, 30 with normal left ventricular ejection fraction (LVEF) ≥ 50% (non-HF group) and 30 with LVEF ≤ 35% (HF group). Multiple high-density bi-atrial CFE maps were acquired along with AF cycle length (AFCL) at each procedural stage. Change in bi-atrial CFE areas, AFCL and outcome data were then compared. In the non-HF group, higher CFE-areas were found at baseline and at each step of the procedure in the LA. In both LA and the right atrium (RA), baseline and final CFE area were also higher in the non-HF group. Single procedure, arrhythmia-free survival at 1 year was higher in the HF group compared with the non-HF group (72% vs. 43%, log rank P = 0.04). Final total bi-atrial CFE area was an independent predictor of arrhythmia recurrence. Conclusions CFE represents an important surrogate marker of atrial substrate complexity. The atrial substrate in persistent AF differs between HF and non-HF with the latter representing a more complex 'primary' bi-atrial myopathy. LA focussed ablation results in more extensive substrate modification in HF and better clinical outcomes as compared with non-HF.
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Affiliation(s)
- Shouvik K Haldar
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - David G Jones
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Habib Khan
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Sandeep Panikker
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Julian W E Jarman
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Charlie Butcher
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Eric Lim
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Gareth Wynn
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.,Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Wajid Hussain
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Vias Markides
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
| | - Tom Wong
- Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK
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9
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The new age of atrial fibrillation: Back to the lab. J Thorac Cardiovasc Surg 2018; 156:1880. [DOI: 10.1016/j.jtcvs.2018.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 11/23/2022]
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Pojar M, Haman L, Parizek P, Myjavec A, Gofus J, Vojacek J. Midterm outcomes of mini-invasive surgical and hybrid ablation of atrial fibrillation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:233-240. [PMID: 30214077 DOI: 10.5507/bp.2018.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We evaluated the feasibility and effectiveness of thoracoscopic and a staged surgical and transcatheter ablation technique to treat stand-alone atrial fibrillation (AF). METHODS . Between 2009 and 2016, a cohort of 65 patients underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n=30; 46%), persistent AF (n=18; 28%) or long-standing persistent AF (n=17; 26%) followed by catheter ablation in case of AF recurrence. Surgical box lesion procedure included bilateral pulmonary vein and left atrial posterior wall ablation using irrigated bipolar radiofrequency with documentation of conduction block. RESULTS There were no intra- or peri-operative ablation-related complications. There was no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 120.5 ± 22.0 min and the postoperative average length of stay was 8.1 ± 3.0 days. At discharge, 60 patients (92%) were in sinus rhythm. Median follow-up time was 866 days (IQR, 612-1185 days). One-year success rate after surgical procedure was 78% (off antiarrhythmic drugs). Eleven patients (17%) underwent catheter re-ablation. Sixty (92%) patients were free of atrial fibrillation after hybrid ablation (on demand) at 1 year follow up after the last ablation. The success at 24-months was achieved in 96% (paroxysmal) and 78% (persistent) patients. At the last follow-up control, 69% patients discontinued oral anticoagulant therapy. CONCLUSIONS . Combination of mini-invasive surgical and endocardial treatment (two-stage hybrid procedure) is a safe and effective method for the treatment of isolated (lone) AF. This procedure provided good midterm outcomes.
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Affiliation(s)
- Marek Pojar
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
| | - Ludek Haman
- 1 st Department of Cardiovascular Medicine, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
| | - Petr Parizek
- 1 st Department of Cardiovascular Medicine, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
| | - Andrej Myjavec
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
| | - Jan Gofus
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital in Hradec Kralove, Czech Republic
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12
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Pereda D, Quintana E, Mestres CA. Late atrial fibrillation in bilateral lung and heart transplants: Apples and oranges? Asian Cardiovasc Thorac Ann 2016; 24:779-781. [PMID: 27634825 DOI: 10.1177/0218492316669273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carlos-A Mestres
- Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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13
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Kyprianou K, Pericleous A, Stavrou A, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Surgical perspectives in the management of atrial fibrillation. World J Cardiol 2016; 8:41-56. [PMID: 26839656 PMCID: PMC4728106 DOI: 10.4330/wjc.v8.i1.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/08/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials.
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Did you write a protocol before starting your project? Gen Thorac Cardiovasc Surg 2014; 63:71-7. [DOI: 10.1007/s11748-014-0478-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Indexed: 10/24/2022]
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Pojar M, Vojacek J, Haman L, Parizek P, Omran N, Vobornik M, Harrer J. Thoracoscopic Radiofrequency Ablation for Lone Atrial Fibrillation:
Box-Lesion Technique. J Card Surg 2014; 29:757-62. [DOI: 10.1111/jocs.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marek Pojar
- Department of Cardiac Surgery, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Ludek Haman
- 1st Department of Cardiovascular Medicine, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Petr Parizek
- 1st Department of Cardiovascular Medicine, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Nedal Omran
- Department of Cardiac Surgery, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Martin Vobornik
- Department of Cardiac Surgery, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Jan Harrer
- Department of Cardiac Surgery, Charles University in Prague; Faculty of Medicine and University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
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Kwak JG, Seo JW, Oh SS, Lee SY, Ham EK, Kim WH, Kim SJ, Bae EJ, Lim C, Lee CH, Lee C. Histopathologic analysis of atrial tissue in patients with atrial fibrillation: comparison between patients with atrial septal defect and patients with mitral valvular heart disease. Cardiovasc Pathol 2014; 23:185-92. [PMID: 24746709 DOI: 10.1016/j.carpath.2014.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) in adult patients with atrial septal defect (ASD) accompanies an enlarged right atrium (RA) with a less enlarged left atrium (LA), which is the opposite situation in patients with AF and mitral valvular disease. This study was to compare the histopathological change in the atrium of patients with AF of two different etiologies: ASD and mitral disease. METHODS Twenty-four patients were enrolled. Group 1 included patients with ASD (8), Group 2 included patients with ASD with AF (6), and Group 3 included patients with mitral disease with AF (10). Preoperative atrial volumes were measured. Atrial tissues were obtained during surgical procedures and stained with periodic acid-Schiff, smooth muscle actin, Sirius red, and Masson's trichrome to detect histopathologic changes compatible with AF. The severity of histopathological changes was represented with "positivity" and "strong positivity" after analyzing digitalized images of the staining. We investigated the relationship between the degree of atrial dilatation and severity of histopathological changes according to the groups and tissues. RESULTS Group 2 and Group 3 patients showed a tendency toward an enlarged RA volume and enlarged LA volume, respectively, compared with each others. However, in the histopathologic analysis, "positivity" and "strong positivity" showed no significant positive correlations with the degree of atrial volume in special staining. CONCLUSIONS A similar degree of histopathologic changes was observed in both atria in patients with AF (Group 2 and 3) regardless of the degree of dilatation of atrial volume and disease entities.
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Affiliation(s)
- Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hostpial, Bucheon, Republic of Korea
| | - Jeong-Wook Seo
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sam Se Oh
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hostpial, Bucheon, Republic of Korea
| | - Sang Yun Lee
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Eui Keun Ham
- Department of Pathology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
| | - Soo-Jin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Cheoung Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hostpial, Bucheon, Republic of Korea
| | - Cheul Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hostpial, Bucheon, Republic of Korea
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Cox JL. Mechanical closure of the left atrial appendage: is it time to be more aggressive? J Thorac Cardiovasc Surg 2013; 146:1018-1027.e2. [PMID: 23993272 DOI: 10.1016/j.jtcvs.2013.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Affiliation(s)
- James L Cox
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
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Early and Long-Term Mortality in 536 Patients After the Cox-Maze III Procedure: A National Registry-Based Study. Ann Thorac Surg 2013; 95:1626-32. [DOI: 10.1016/j.athoracsur.2013.01.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 01/18/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
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Bakker RC, Akin S, Rizopoulos D, Kik C, Takkenberg JJM, Bogers AJJC. Results of clinical application of the modified maze procedure as concomitant surgery. Interact Cardiovasc Thorac Surg 2012; 16:151-6. [PMID: 23103720 DOI: 10.1093/icvts/ivs440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Atrial fibrillation is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The classic cut-and-sew maze procedure is successful in 85-95% of patients. However, the technical complexity has prompted modifications of the maze procedure. The objective of this study was to retrospectively evaluate the clinical safety and efficacy of the maze treatment performed at our institution. METHODS From March 2001 until February 2009, 169 patients underwent a modified maze procedure for atrial fibrillation at the Erasmus MC, Rotterdam. Patient characteristics, surgical procedure and follow-up data were obtained by reviewing the medical charts and consulting with the referring physicians. The efficacy of the procedure as measured by AF recurrence was analysed with a repeated measurements model. The quality of life of the patients was assessed with the SF-36 (a short-form health survey with 36 questions) questionnaire and compared with that of the general Dutch population. RESULTS Of the 169 patients who underwent a modified maze procedure, 163 had their maze procedure as a concomitant procedure. The 30-day mortality rate was 4.7% (n = 8). The rate of post-procedural AF recurrence varied significantly over time (P < 0.0001). Decreased left ventricular function, increased age and higher preoperative creatinine levels were predictors of AF recurrence. Quality of life, as measured with the SF-36 questionnaire, was comparable with that of the Dutch population for all health domains. CONCLUSIONS Concomitant maze is a relatively safe treatment that eliminates atrial fibrillation in the majority of patients, although the probability of recurrent AF increases with the passage of time. Decreased left ventricular function, increased age and higher preoperative creatinine levels are associated with an increased risk of AF recurrence.
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Affiliation(s)
- Robbert C Bakker
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Lee R, McCarthy PM, Wang EC, Vaduganathan M, Kruse J, Malaisrie SC, McGee EC. Midterm survival in patients treated for atrial fibrillation: A propensity-matched comparison to patients without a history of atrial fibrillation. J Thorac Cardiovasc Surg 2012; 143:1341-51; discussion 1350-1. [DOI: 10.1016/j.jtcvs.2012.02.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 01/12/2012] [Accepted: 02/03/2012] [Indexed: 11/30/2022]
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Ahlsson A, Jidéus L, Albåge A, Källner G, Holmgren A, Boano G, Hermansson U, Kimblad PO, Scherstén H, Sjögren J, Ståhle E, Åberg B, Berglin E. A Swedish consensus on the surgical treatment of concomitant atrial fibrillation. SCAND CARDIOVASC J 2012; 46:212-8. [DOI: 10.3109/14017431.2012.671489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hanke T, Sievers HH. [Surgical atrial fibrillation ablation therapy and postoperative monitoring]. Herz 2011; 36:688-95. [PMID: 22012300 DOI: 10.1007/s00059-011-3533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation represents the most common atrial arrhythmia seen in clinical practice. The surgical treatment of atrial fibrillation is recommended in symptomatic patients as well as in asymptomatic patients at low postoperative risk. As a "stand alone" procedure, surgical ablation therapy is indicated after failed catheter ablation therapy, which occurs increasingly due to the high number of catheter-based ablation techniques. In order to gain acceptance among patients as well as referring cardiologists, the surgical ablation procedure ought to be performed in a minimally invasive fashion and with a very high success rate. When applied in an interdisciplinary approach by cardiologists/electrophysiologists and cardiothoracic surgeons, both ablative techniques have the potential to treat atrial fibrillation effectively and in the long-term. In order to document the true heart rhythm after ablation therapy, intermittent "snapshot" ECG documentation ought to be avoided. Small leadless devices that can be implanted subcutaneously enable full heart rhythm disclosure with documentation of atrial arrhythmias. The modern technique of implantable loop recorders permits individualized treatment for each patient.
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Affiliation(s)
- T Hanke
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
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Reply. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Harling L, Athanasiou T, Ashrafian H, Nowell J, Kourliouros A. Strategies in the surgical management of atrial fibrillation. Cardiol Res Pract 2011; 2011:439312. [PMID: 21747988 PMCID: PMC3130973 DOI: 10.4061/2011/439312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/07/2011] [Accepted: 03/10/2011] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.
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Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
| | - Justin Nowell
- Department of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
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Gillinov AM, Argenziano M, Blackstone EH, Iribarne A, DeRose JJ, Ailawadi G, Russo MJ, Ascheim DD, Parides MK, Rodriguez E, Bouchard D, Taddei-Peters WC, Geller NL, Acker MA, Gelijns AC. Designing comparative effectiveness trials of surgical ablation for atrial fibrillation: experience of the Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg 2011; 142:257-64.e2. [PMID: 21616507 DOI: 10.1016/j.jtcvs.2011.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 03/25/2011] [Accepted: 04/11/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Since the introduction of the cut-and-sew Cox maze procedure for atrial fibrillation, there has been substantial innovation in techniques for ablation. Use of alternative energy sources for ablation simplified the procedure and has resulted in dramatic increase in the number of patients with atrial fibrillation treated by surgical ablation. Despite its increasingly widespread adoption, there is lack of rigorous clinical evidence to establish this procedure as an effective clinical therapy. METHODS This article describes a comparative effectiveness randomized trial, supported by the Cardiothoracic Surgical Clinical Trials Network, of surgical ablation with left atrial appendage closure versus left atrial appendage closure alone in patients with persistent and long-standing persistent atrial fibrillation undergoing mitral valve surgery. Nested within this trial is a further randomized comparison of 2 different lesions sets: pulmonary vein isolation and the full maze lesion set. RESULTS This article addresses trial design challenges, including how best to characterize the target population, operationalize freedom from atrial fibrillation as a primary end point, account for the impact of antiarrhythmic drugs, and measure and analyze secondary end points, such as postoperative atrial fibrillation load. CONCLUSIONS This article concludes by discussing how insights that emerge from this trial may affect surgical practice and guide future research in this area.
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Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Nakamura T, Izutani H, Sawa Y. Mid-term outcomes of the modified Cox-maze procedure for elderly patients: a risk analysis for failure. Interact Cardiovasc Thorac Surg 2011; 12:924-8. [PMID: 21436130 DOI: 10.1510/icvts.2010.263491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the maze procedure is highly effective for most patients with atrial fibrillation (AF), its standardized application to elderly patients is controversial. Between 2004 and 2007, 143 patients with a mean age of 65 years of age or older underwent the modified Cox-maze procedure concomitant with other cardiac procedures. The follow-up data were available from 128 patients, and the mean follow-up period was 37.1 months. The overall sinus rhythm (SR) rate at the latest follow-up was 74.2%. The cumulative freedom from AF without antiarrhythmic medication was 65.2% at five years. Stroke was less prevalent in patients with a stable SR than in those with a recurrence of AF. There were two patients (1.6%) who required permanent pacemaker placement during follow-up. Multivariate analysis demonstrated that a duration of AF >5 years, a fine f-wave and a dimension of the left atrium ≥60 mm were independent risk factors for recurrent AF. The Cox proportional hazard model showed that the former two factors independently affected freedom from recurrence. In conclusion, the modified Cox-maze procedure was safe and beneficial for patients 65 years of age or older, supporting that the limited biatrial ablation might be sufficient for elderly patients without risk factors for recurrence.
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Affiliation(s)
- Teruya Nakamura
- Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, Kure 737-0023, Japan.
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Onorati F, Mariscalco G, Rubino AS, Serraino F, Santini F, Musazzi A, Klersy C, Sala A, Renzulli A. Impact of Lesion Sets on Mid-Term Results of Surgical Ablation Procedure for Atrial Fibrillation. J Am Coll Cardiol 2011; 57:931-40. [DOI: 10.1016/j.jacc.2010.09.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
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El tratamiento quirúrgico de las arritmias cardíacas. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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