Atrial Fibrillation Correction Surgery: Lessons From The Society of Thoracic Surgeons National Cardiac Database
Duke University, Durham, North Carolina, United States The Annals of thoracic surgery
(Impact Factor: 3.85).
04/2008; 85(3):909-14. DOI: 10.1016/j.athoracsur.2007.10.097
We used The Society of Thoracic Surgeons National Cardiac Database to document the utilization of surgical atrial fibrillation (AF) correction procedures in North America. We also examined the subset of patients having mitral valve surgery to determine whether concurrent surgical AF correction procedures were associated with an increased risk of morbidity or mortality.
Retrospective review of outcomes for 67,389 patients with AF having cardiac surgery between January 2004 and December 2006 was conducted. Multivariable logistic regression was performed to assess whether concomitant AF correction procedures increased risk in the mitral valve surgery cohort.
Overall, 38% (25,718 of 67,389) of patients with AF undergoing cardiac surgery had an AF correction procedure, increasing from 28.1% in 2004 to 40.2% in 2006. Surgical AF correction was performed in 52% (6,415 of 12,235) of mitral valve surgery patients, 28% (2,965 of 10,590) of those having aortic valve surgery, and 24% (5,438 of 22,388) of those having isolated coronary artery bypass grafting. After adjusting for differences in preoperative characteristics, mitral valve surgery patients with a surgical AF correction procedure did not have a significantly higher risk of mortality (adjusted odds ratio, 1.00; 95% confidence interval, 0.83 to 1.20) or major morbidity. The risk for new permanent pacemaker implantation was higher (adjusted odds ratio, 1.26; 95% confidence interval, 1.07 to 1.49) in the AF correction with mitral valve surgery group.
Although a growing number of patients with AF are treated with concurrent AF correction procedures during cardiac surgery, nearly 60% of patients are left untreated. Among patients with AF and mitral valve disease, the addition of an AF correction procedure does not increase perioperative morbidity or mortality.
Available from: Tinică Grigore
- "This arrhythmia is a considerable long-term risk factor that influences the evolution and survival of patients having required heart surgery . Also, the literature data revealed a significant connection between the patients' old age that needed such revascularization surgery and the atrial fibrillation incidence [2, 3]. Although it is well known that preoperative AFib increases the postoperative mortality of patients having undergone heart surgery, the literature provides little information on the way in which this arrhythmia impedes upon the postoperative outcome of patients having undergone such surgical procedures, considering the numerous complications that may occur in the evolution of these patients. "
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ABSTRACT: Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospectively, over a 10-year period, from all the patients who had undergone heart surgery in our Institute. The study group included 1119 heart surgery patients, who were divided as follows: the preoperative AFib group (n = 226, 20.19%) and the sinus rhythm group (n = 893, 79.80%). Major postoperative complications and hospital mortality rates were analyzed. According to our statistical analysis, preoperative atrial fibrillation significantly increased the mortality risk (P = 0.001), the patients' mechanical ventilation needs (P = 0.022), the rate of occurrence of infectious complications (P < 0.5), the rate of occurrence of complications such as acute kidney failure (P = 0.012), and the time spent by the patients in the intensive care ward (P < 0.01). In conclusion, preoperative atrial fibrillation in heart surgery patients increases the mortality and major complication risk further to heart surgery.
Available from: icvts.oxfordjournals.org
- "As previously shown in multivariable analyses and propensity-matched studies, preexisting AF significantly reduces survival after cardiac surgery. Atrial fibrillation has also been found to be an independent risk factor after cardiac surgery891011. Good results have been reported after AF surgery/ablation. "
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ABSTRACT: We report our experience with a modified mini-maze procedure and pulmonary vein isolation using radiofrequency energy for treating persistent atrial fibrillation during coronary artery bypass grafting (CABG).
Ninety-five patients with persistent atrial fibrillation and coronary heart disease underwent open heart surgery combined with intraoperative irrigated radiofrequency ablation. Patients were randomized into the following three groups: CABG and irrigated radiofrequency pulmonary vein isolation (CABG+PVI, n = 31); CABG and an irrigated radiofrequency modified mini-maze procedure (CABG+MM, n = 30); and isolated CABG (CABG alone, n = 34). All patients received implantable loop recorders.
No reoperation and no hospital mortality were recorded. Mean follow-up was 14.4 ± 9.7 months. The implantable loop recorder-determined freedom from atrial fibrillation was 80% in the CABG+PVI group, 86.2% in the CABG+MM group and 44.1% in the CABG alone group.
Patients with concomitant atrial fibrillation and coronary heart disease may benefit from intraoperative ablation to prevent relapse of arrhythmia.
Available from: Petr Budera
- "However, many surgeons do not routinely treat AF with a
concomitant cardiac surgical procedure. Gammie et al.7 recently reported that in nearly
60% of patients undergoing cardiac surgery, concomitant AF is left untreated. This
may be due to the variety of lesion sets and energy sources, but may also be due to the lack
of clinically convincing results. "
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ABSTRACT: AimsSurgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes.Methods and resultsThis multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n = 117) vs. group B (no ablation, n = 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2% of group A patients vs. 35.5% in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3% (group A) vs. 14.7% (group B, P = 0.411). All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P = 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9%, P < 0.001).Conclusion
Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later.
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