Page 100 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Addendum
cardioversion procedure proved to be of utmost importance. Ideally the ECV should be performed within 88 days post-surgery. Left atrial (LA) dimensions were significantly more reduced in patients with associated ablation surgery than in those with isolated mitral valve surgery, probably because of scarring along the ablation lines or because of reverse remodelling of the atria. Amiodarone improved the ECV success rate only in patients without add-on ablation surgery. Chapter 6 explores the real-life OAC treatment after ablation surgery and examines whether this treatment is adherent to the current guidelines.The main finding was that OAC prescription before and after surgical ablation in AF patients was hardly guided by the patient’s individual stroke risk. Contrary to current recommendations, the rate of OAC remains high even in patients with a low stroke risk.The most important factors that influence the use of anticoagulants seem to be older age, type of AF, preoperative OAC use and other indications for OAC use than AF.This results in possible over-treatment of low-risk patients and under-treatment of high-risk patients. Over-treatment and under-treatment did not show significant differences in stroke or bleeding risk.
Chapter 7 discusses a multicentre trial analysing the long-term outcomes of patients undergoing add-on radiofrequency (RF) ablation. The findings confirm the superiority of a bipolar source for rhythm outcome and transmurality of the lesions. Furthermore, right-sided atrial ablations in addition to left-sided lines lead to better long-term rhythm outcome. LA connecting lesions and mitral isthmus lines do not show to be significant predictors for AF recurrence. Further studies are necessary to confirm these findings.
Chapter 8 provides a review of the ‘hybrid procedure’ for the treatment of LAF. In this technique percutaneous epicardial catheter ablation (PECA) and endocardial ablation are combined. Papers selected for this review were identified on PUBMED and the final selection included nine studies.The hybrid approach achieved satisfactory results, with atrial fibrillation-antiarrhythmic drug- free success rates higher than in isolated procedures. In particular, the bilateral approach with a bipolar device had a high success rate and seems to be the better choice for the hybrid procedure. Despite good preliminary results, large, multicentre trials on hybrid atrial fibrillation ablation, that target a population of patients with long-standing-persistent disease, are necessary to establish whether this approach may in the future represent the gold-standard treatment for atrial fibrillation.
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