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Thorac Cardiovasc Surg 2023; 71(04): 255-263
DOI: 10.1055/s-0042-1750311
Original Cardiovascular

The German Cardiosurgery Atrial Fibrillation Registry: 1-Year Follow-up Outcomes

Mahmoud Wehbe 
1   Schüchtermann-Schiller'sche Hospital Group Bad Rothenfelde, Bad Rothenfelde, Germany
,
Marc Albert
2   Department of Cardiac Surgery, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Baden-Württemberg, Germany
,
Thorsten Lewalter
3   Peter Osypka Herzzentrum - Internal Medicine München Süd, München, Germany
,
Taoufik Ouarrak
4   Stiftung für Herzinfarkt Forschung, Bremserstraße 79, Ludwigshafen am Rhein, Germany
,
Jochen Senges
4   Stiftung für Herzinfarkt Forschung, Bremserstraße 79, Ludwigshafen am Rhein, Germany
,
Thorsten Hanke
5   Universitätsklinikum Schleswig-Holstein, Campus Lübeck - Asklepios Klinik Harburg, Hamburg, Germany
,
Nicolas Doll
6   Department of Cardiac Surgery, Schüchtermann-Schiller'sche Hospital Group Bad Rothenfelde, Bad Rothenfelde, Germany
› Author Affiliations Funding Statement This work was supported by a grant from AtriCure Europe BV, De I 260, 1101 EE Amsterdam Z. O.
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Abstract

Objectives This study of German Cardiosurgery Atrial Fibrillation (CASE-AF) registry aims to describe the 1-year outcomes of patients undergoing ablative procedures for atrial fibrillation (AF) in a cardiosurgical setting.

Methods Between January 2017 and April 2020, 17 German cardiosurgical units enrolled 1,000 consecutive patients undergoing concomitant or stand-alone ablation for AF. In-hospital and 1-year follow-up data were collected on web-based electronic case report forms. The protocol mandated telephone-based follow-up contact after 1 year.

Results At 1-year follow-up (median, 14.5 months [12.6–18.2 months]), significant improvement (p < 0.0001) in baseline modified European Heart Rhythm Association Class I was reported in both concomitant and stand-alone patients. Follow-up examinations were completed in 97.9% of cases, and a sinus rhythm was reported in 60.2 and 63.6% of stand-alone and concomitant patients, respectively. Statistically significant factors determining late recurrence were female gender (p = 0.013), preoperative persistent AF (p < 0.0001), and presence of cardiac implantable electronic device (p = 0.011). All-cause mortality at 1 year was 1% (n = 1) in stand-alone patients and 6.7% (n = 58) in concomitant patients.

Conclusion Surgical ablation of AF is safe and provides satisfactory results at short-term follow-up, with significant improvement in patient symptoms. Adequate cardiac rhythm monitoring should be prioritized for higher quality data acquisition.

Keywords

arrhythmia therapy - minimally invasive surgery - heart valve surgery

Note

ClinicalTrials.gov Identifier: NCT03091452. https://clinicaltrials.gov/ct2/show/NCT03091452.




Publication History

Received: 13 March 2022

Accepted: 12 May 2022

Article published online:
27 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12 (01) 2-14
    CrossrefPubMedSearch in Google Scholar
  • 2 Wehbe M, Albert M, Lewalter T. et al; CASE-AF Investigators. The German CArdioSurgEry Atrial Fibrillation registry: in-hospital outcomes. Thorac Cardiovasc Surg 2021; (e-pub ahead of print).
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Kirchhof P, Benussi S, Kotecha D. et al; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38) 2893-2962
    CrossrefPubMedSearch in Google Scholar
  • 4 Wynn GJ, Todd DM, Webber M. et al. The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification. Europace 2014; 16 (07) 965-972
    CrossrefPubMedSearch in Google Scholar
  • 5 Calkins H, Hindricks G, Cappato R. et al; Document Reviewers. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20 (01) e1-e160
    CrossrefPubMedSearch in Google Scholar
  • 6 Erdogan A, Carlsson J, Neumann T. et al. Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up. Pacing Clin Electrophysiol 2003; 26 (03) 678-684
    CrossrefPubMedSearch in Google Scholar
  • 7 Grady KL, Lee R, Subačius H. et al. Improvements in health-related quality of life before and after isolated cardiac operations. Ann Thorac Surg 2011; 91 (03) 777-783
    CrossrefPubMedSearch in Google Scholar
  • 8 Kasirajan V, Spradlin EA, Mormando TE. et al. Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation. Ann Thorac Surg 2012; 93 (05) 1456-1461
    CrossrefPubMedSearch in Google Scholar
  • 9 Walfridsson H, Walfridsson U, Nielsen JC. et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace 2015; 17 (02) 215-221
    CrossrefPubMedSearch in Google Scholar
  • 10 Driessen AHG, Berger WR, Bierhuizen MFA. et al. Quality of life improves after thoracoscopic surgical ablation of advanced atrial fibrillation: results of the Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery (AFACT) study. J Thorac Cardiovasc Surg 2018; 155 (03) 972-980
    CrossrefPubMedSearch in Google Scholar
  • 11 Raissouni K, Petrosyan A, Malapert G, Jazayeri S, Morgant MC, Bouchot O. Concomitant cardiac surgery and radiofrequency ablation of atrial fibrillation: a retrospective single center study. J Cardiothorac Vasc Anesth 2020; 34 (02) 401-408
    CrossrefPubMedSearch in Google Scholar
  • 12 Blomström-Lundqvist C, Johansson B, Berglin E. et al. A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J 2007; 28 (23) 2902-2908
    CrossrefPubMedSearch in Google Scholar
  • 13 Abreu Filho CAC, Lisboa LAF, Dallan LAO. et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation 2005; 112 (9, Suppl): I20-I25
    PubMedSearch in Google Scholar
  • 14 Verma A, Champagne J, Sapp J. et al. Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Intern Med 2013; 173 (02) 149-156
    CrossrefPubMedSearch in Google Scholar
  • 15 Arbelo E, Brugada J, Blomström-Lundqvist C. et al; on the behalf of the ESC-EHRA Atrial Fibrillation Ablation Long-term Registry Investigators. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J 2017; 38 (17) 1303-1316
    PubMedSearch in Google Scholar
  • 16 Haldar S, Khan HR, Boyalla V. et al. Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial. Eur Heart J 2020; 41 (47) 4471-4480
    CrossrefPubMedSearch in Google Scholar
  • 17 Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 1991; 101 (04) 584-592
    CrossrefPubMedSearch in Google Scholar
  • 18 Cox JL, Ad N, Palazzo T. et al. Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12 (01) 15-19
    CrossrefPubMedSearch in Google Scholar
  • 19 Pison L, La Meir M, van Opstal J, Blaauw Y, Maessen J, Crijns HJ. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol 2012; 60 (01) 54-61
    CrossrefPubMedSearch in Google Scholar
  • 20 Maesen B, Pison L, Vroomen M. et al. Three-year follow-up of hybrid ablation for atrial fibrillation. Eur J Cardiothorac Surg 2018; 53 (Suppl. 01) i26-i32
    CrossrefPubMedSearch in Google Scholar
  • 21 Gaynor SL, Schuessler RB, Bailey MS. et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg 2005; 129 (01) 104-111
    CrossrefPubMedSearch in Google Scholar
  • 22 Pecha S, Schäfer T, Subbotina I, Ahmadzade T, Reichenspurner H, Wagner FM. Rhythm outcome predictors after concomitant surgical ablation for atrial fibrillation: a 9-year, single-center experience. J Thorac Cardiovasc Surg 2014; 148 (02) 428-433
    CrossrefPubMedSearch in Google Scholar
  • 23 Gillinov AM, Bhavani S, Blackstone EH. et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg 2006; 82 (02) 502-513 , discussion 513–514
    CrossrefPubMedSearch in Google Scholar
  • 24 Sultan A, Lüker J, Andresen D. et al. Predictors of atrial fibrillation recurrence after catheter ablation: data from the German Ablation registry. Sci Rep 2017; 7 (01) 16678
    CrossrefPubMedSearch in Google Scholar
  • 25 Hindricks G, Potpara T, Dagres N. et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42 (05) 373-498
    Search in Google Scholar
  • 26 Huffman MD, Karmali KN, Berendsen MA. et al. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery. Cochrane Database Syst Rev 2016; (08) CD011814
    PubMedSearch in Google Scholar
  • 27 Wehbe MS, Doll N, Merk DR. Fatal complications associated with surgical left atrial appendage exclusion. J Thorac Cardiovasc Surg 2018; 156 (06) e207-e208
    CrossrefPubMedSearch in Google Scholar
  • 28 Hanke T, Charitos EI, Stierle U. et al. Twenty-four-hour holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 2009; 120 (11, Suppl): S177-S184
    CrossrefPubMedSearch in Google Scholar