Page 27 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

3. Most of the ablation lines are made epicardially; therefore the number of
endocardial application ablation lines employed is small with consequent 1 reduction in the occurrence of embolic events, which may complicate
endocardial ablation.
Potential disadvantages are:
1. The procedure is time consuming and significantly longer than surgery-
alone techniques and
2. The heparinization of the patient after the septal puncture might cause
bleeding of surgically dissected areas.
However, the efficacy of this procedure as well as its potential superiority over catheter ablation or standard surgical technique has to be proven by large comparative studies.
Health related quality of life (HrQoL) measurement in AF
Since 1948, when the World Health Organisation defined health as being not only the absence of disease, but also as the presence of physical, mental and social well-being, quality of life (QoL) has become more important in health care practice and research152. So in addition to purely clinical criteria such as morbidity and mortality, enhancing QoL has gradually been accepted as one of the reasons to treat patients with AF. QoL in AF will be diminished due to palpitations, dyspnoea, dizziness, syncope, fatigue and decreased exercise tolerance. Although the concept of QoL is complex and no universal definition exists, there is an emerging consensus that quality of life can be assessed on the basis of four components153-154: physical condition, psychological well-being, maintenance of social activities and performance of everyday activities. In this respect, the benefit of chronic SR has to outweigh the risks of a prolonged operation. In addition, cardiovascular complaints unrelated to AF may persist even after successful surgery, thus offsetting the benefit of maintaining chronic SR.At the present time we do not know whether add-on ablation surgery indeed affects morbidity and QoL, since randomised trials are lacking.
Besides enhancing QoL, as discussed above, preventing the use of oral anticoagulation (OAC) is a key-point issue in finding a definite treatment strategy for AF. Since AF is a major risk factor for stroke and trombo-embolism,
Introduction
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