RSS-Feed abonnieren
DOI: 10.1055/s-0041-1731772
Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity
Funding The Rusche grant of the German Society of Thoracic and Cardiovascular Surgery (DGTHG) and the German Heart Foundation (Deutsche Herzstiftung) as well as UKGM research funding supported B.N. S.R. was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Projektnummer 268555672–SFB 1213, Project B03 and B06. The Rusche grant of the German Society of Thoracic and Cardiovascular Surgery (DGTHG) and the German Heart Foundation (Deutsche Herzstiftung) UKGM research funding. Deutsche Forschungsgemeinschaft (DFG, German Research Foundation). Projektnummer 268555672–SFB 1213, Project B03 and B06.![](https://www.thieme-connect.de/media/thoracic/202304/lookinside/thumbnails/10-1055-s-0041-1731772_216206oc-1.jpg)
Abstract
Objectives Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study.
Methods Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling.
Results Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: −6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (−7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF.
Conclusions Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.
Authors' Contribution
SR, ED, LL, FK, SV, NM, AB, and BN participated and contributed to conception and design of the study. SR, ED, SV, NM, AB, and BN contributed to conception, design, and interpretation of clinical science data. SR, AB, ED, and BN participated in drafting of the manuscript.
* Both authors contributed equally.
Publikationsverlauf
Eingereicht: 16. Februar 2021
Angenommen: 27. April 2021
Artikel online veröffentlicht:
14. September 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Schnabel RB, Yin X, Gona P. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 2015; 386 (9989): 154-162
- 2 Ball J, Carrington MJ, McMurray JJ, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol 2013; 167 (05) 1807-1824
- 3 Gammie JS, Haddad M, Milford-Beland S. et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg 2008; 85 (03) 909-914
- 4 Musharbash FN, Schill MR, Sinn LA. et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg 2018; 155 (01) 159-170
- 5 Badhwar V, Rankin JS, Ad N. et al. Surgical ablation of atrial fibrillation in the united states: trends and propensity matched outcomes. Ann Thorac Surg 2017; 104 (02) 493-500
- 6 Ad N, Henry L, Hunt S. The impact of surgical ablation in patients with low ejection fraction, heart failure, and atrial fibrillation. Eur J Cardiothorac Surg 2011; 40 (01) 70-76
- 7 Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, and clinical impact. Clin Cardiol 2017; 40 (06) 413-418
- 8 Wang X, Wang C, Ye M. et al. Left atrial concomitant surgical ablation for treatment of atrial fibrillation in cardiac surgery: a meta-analysis of randomized controlled trials. PLoS One 2018; 13 (01) e0191354 DOI: 10.1371/journal.pone.0191354.
- 9 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50 (05) e1-e88
- 10 Belley-Cote EP, Singal RK, McClure G. et al. Perspective and practice of surgical atrial fibrillation ablation: an international survey of cardiac surgeons. Europace 2019; 21 (03) 445-450
- 11 Benussi S, de Maat GE. Atrial remodelling and function: implications for atrial fibrillation surgery. Eur J Cardiothorac Surg 2018; 53 (Suppl. 01) i2-i8
- 12 Thomas L, Abhayaratna WP. Left atrial reverse remodeling: mechanisms, evaluation, and clinical significance. JACC Cardiovasc Imaging 2017; 10 (01) 65-77
- 13 Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 2017; 120 (09) 1501-1517
- 14 Calkins H, Hindricks G, Cappato R. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14 (10) e275-e444
- 15 Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable risk factors and atrial fibrillation. Circulation 2017; 136 (06) 583-596
- 16 Dzeshka MS, Lip GY, Snezhitskiy V, Shantsila E. Cardiac fibrosis in patients with atrial fibrillation: mechanisms and clinical implications. J Am Coll Cardiol 2015; 66 (08) 943-959
- 17 Jamaly S, Carlsson L, Peltonen M, Jacobson P, Sjöström L, Karason K. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. J Am Coll Cardiol 2016; 68 (23) 2497-2504
- 18 Phan K, Xie A, Kumar N. et al. Comparing energy sources for surgical ablation of atrial fibrillation: a Bayesian network meta-analysis of randomized, controlled trials. Eur J Cardiothorac Surg 2015; 48 (02) 201-211
- 19 Whitlock R, Healey J, Vincent J. et al. Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III. Ann Cardiothorac Surg 2014; 3 (01) 45-54
- 20 Rohla M, Weiss TW, Pecen L. et al. Risk factors for thromboembolic and bleeding events in anticoagulated patients with atrial fibrillation: the prospective, multicentre observational PREvention oF thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF). BMJ Open 2019; 9 (03) e022478 DOI: 10.1136/bmjopen-2018-022478.
- 21 Badhwar V, Rankin JS, Damiano Jr RJ. et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2017; 103 (01) 329-341
- 22 Iribarne A, DiScipio AW, McCullough JN. et al; Northern New England Cardiovascular Disease Study Group. Surgical atrial fibrillation ablation improves long-term survival: a multicenter analysis. Ann Thorac Surg 2019; 107 (01) 135-142
- 23 Ad N, Henry L, Hunt S, Holmes SD. Impact of clinical presentation and surgeon experience on the decision to perform surgical ablation. Ann Thorac Surg 2013; 96 (03) 763-768 , discussion 768–769
- 24 Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients. Ann Thorac Surg 2016; 102 (02) 573-579
- 25 Atti V, Anantha-Narayanan M, Turagam MK. et al. Surgical left atrial appendage occlusion during cardiac surgery: a systematic review and meta-analysis. World J Cardiol 2018; 10 (11) 242-249
- 26 Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS. Atrial fibrillation and obesity--results of a meta-analysis. Am Heart J 2008; 155 (02) 310-315
- 27 Niemann B, Rohrbach S, Miller MR, Newby DE, Fuster V, Kovacic JC. Oxidative stress and cardiovascular risk: obesity, diabetes, smoking, and pollution: part 3 of a 3-part series. J Am Coll Cardiol 2017; 70 (02) 230-251
- 28 Wong CX, Sullivan T, Sun MT. et al. Obesity and the risk of incident, post-operative, and post-ablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC Clin Electrophysiol 2015; 1 (03) 139-152