Page 101 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

In Chapter 9 the results of this thesis, including the drivers for add-on surgery such as rhythm outcome, HrQoL, cost-effectiveness, substrate modification, OAC prescription and recommendations on ablation set administration and its future directions, are defined. Many aspects of add-on microwave ablation surgery have been poorly investigated and are the main aims of this thesis. It is concluded that add-on ablation surgery with microwave energy did not affect HrQoL, which was not influenced by SR conversion. Furthermore, it is also not considered as being cost-effective. These unsatisfactory results may be explained by the use of microwave energy to make lesions.Add-on ablation surgery with bipolar RF shows better results in SR restoration than both unipolar RF and microwave sources. But after unsuccessful add-on microwave ablation surgery, ECV results were more effective than in patients undergoing isolated cardiac surgery.This might be related to substrate modification induced by ablation surgery, although the initial SR conversion effect was not satisfactory.
Real-life oral anticoagulation prescription after add-on surgery shows a moderate guideline adherence, with high-risk patients being under-treated and low-risk patients being over-treated.
In assessing the importance of lesion set and surgical technique, completeness of left atrial surgical ablation lines with right atrial ablation is a key point for stable, long-term normal sinus rhythm.The mitral isthmus line still represents an unanswered surgical challenge.
The findings of this thesis suggest that add-on microwave ablation surgery is currently not recommended as an intervention for the treatment and/ or management of AF. The hybrid approach is a potentially attractive surgical technique for add-on surgery in AF patients to be tested.
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