Page 73 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

circumstances, it has been reported that > 80% of patients who undergo ECV for persistent AF or atrial flutter after catheter ablation have recurrence21. However, little is known about the benefit of ECV, with or without additional pharmacological pre-treatment, after unsuccessful add-on ablation surgery. Therefore, we report early and mid-term outcomes of patients who underwent ECV for AF recurrence following add-on surgery ablation compared to those who did not undergo concomitant AF ablation. We also examined multiple pre-procedural and peri-procedural variables to determine predictors of AF recurrence after cardioversion.
Moreover, the current management of anticoagulation following add-on ablation surgery is inconsistent and challenging and no guidelines were put in place until recently22 and little work has been done investigating the best anticoagulation treatment strategies after surgical ablation. Indeed, if on one hand interruption of oral anticoagulation (OAC) after a successful procedure may be a safe approach even in patients who are considered to be at high-risk for stroke, on the other hand, due to the large number of a asymptomatic episodes, many centres avoid interruption of OAC in high-risk patients, even after successful surgery.Therefore, it is still uncertain whether real-life OAC following ablation surgery is guided by current guidelines22 and what factors drive the decision to anticoagulate or not these patients in daily clinical practice.
Therefore we investigated the real-life anticoagulation treatment after ablation surgery to examine whether this treatment adheres to current guidelines and we explored all factors related to OAC use pre-operatively and at follow-up.
In addition, the long-term efficacy of add-on surgical ablation has not yet been fully determined and the role of lesion sets on long-term outcome has been poorly defined10.
Hence, we analysed the late outcomes of patients undergoing add-on surgery.
Our main objective was to assess the impact of lesion set and surgical technique
on long-term recurrence of AF.
Finally, because of suboptimal results of both catheter ablation and surgery 9 especially in long-standing persistent AF23, 24. A so-called hybrid approach has
recently been introduced by our group in the clinical scenario.This procedure combines an epicardial and an endocardial ablation; either staged or as a single procedure,through a partnership between the surgeon and the electrophysiologist and it may represent a future step also for add-on surgery.
General discussion
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