Page 28 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Chapter 1
prevention of stroke is an important goal in the management of patients with AF and therefore OAC therapy is widely used.About 1 out of 6 ischaemic strokes is associated with AF and show a worse outcome than for those without AF: portraying higher mortality and morbidity, greater disability, longer hospital stay, increased costs and higher recurrence rate155. Long-term treatment with oral anticoagulation therapy can reduce stroke risk in AF patients by 60%156. Although this mainstream therapy in reduction of stroke risk has been confirmed by multiple trials, it is distressing to note that OAC therapy remains widely underutilized in high-risk patients, insufficiently protecting them against (recurrent) stroke157-158. On the other hand, OAC use in itself can cause serious bleeding complications: therefore OAC should only be prescribed if justified by the patient’s individual stroke risk profile. As ceasing OAC therapy and therefore reducing its risk of complications might be one of the reasons for the definite treatment of AF, it has never been investigated if additional indications for OAC are present within the AF patient population. In other words, does OAC have to be continued even after AF (and its indication for OAC) is cured by ablation surgery for additional individual reasons, therefore discarding OAC-freedom as a reason for curing AF. The impact of AF on health care consumption and its coinciding costs in the Netherlands is high: not only the direct costs of initial and ongoing treatment of AF but also indirect costs related to loss of productivity are considerable. The annual costs of AF in the Netherlands are estimated at €554 million159. Today, costs are an important issue in health care and may even direct options in treatment strategy.Although associated costs of add-on ablation surgery are high, restoration of SR through ablation surgery might still turn out to be cost- effective in the long run. The potential enhanced HrQoL, reduction in health care consumption due to decreased risk in stroke, lower pharmacological drug use and fewer complications due to AF, might outweigh additional surgery costs during long-term follow-up.Therefore add-on ablation surgery could well be cost saving.
AF is common in patients with heart failure (HF) and cardiomyopathy, regardless of underlying aetiology and might even predispose to the each other160-161. It has been thought that restoration and maintenance of sinus rhythm may be of particular importance in patients with HF and cardiomyopathy, although evidence regarding improvement in outcome as survival, trombo-embolic complications and hospitalisation for HF is conflicting162-164. However, patients with HF benefit from ablation surgery for atrial fibrillation with regard to improved NYHA class
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