Page 74 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Chapter 9
Data related to this approach are still scarce thus we gave an overview is given to summarize and discuss results from published articles about hybrid ablation for the treatment of AF to establish the efficacy of this procedure as well as its potential superiority over catheter ablation or standard surgical technique.
Add-on surgery: Quality of life and cost-effectiveness.
EuroQoL, RAND 36-item Health Survey and Multidimensional Fatigue Inventory (MFI) have been widely employed in clinical practice25-32.The EuroQoL consists of two components: description of the respondent’s own health by means of the EuroQoL thermometer (visual analogue scale [VAS]) and the EuroQoL classification (EQ-5D, mobility, self care, usual activities, pain/discomfort, and anxiety/depression) 25.The RAND 36-item Health Survey 1.0 (SF-36) comprises eight multi-item scales (Physical functioning, Mental health, Physical pain,Vitality, Role limitations due to emotional problems, Role limitations due to physical limitations, Social functioning, General health) 30.The MFI is a 5-item self-report (General fatigue, Physical fatigue, Reduced activity, Reduced motivation, Mental fatigue)32.
In our clinical trial (Chapter 2) all the above questionnaires were self-administered before add-on surgery (baseline).They were then mailed to patients’ home 3, 6, and 12 months after surgery.
In our experience, add-on ablative surgery performed using microwave energy. After one year led to successful 1-year SR conversion in 57% of cases. On the contrary, 42% of patients in the control group (no additional ablation surgery) converted to NSR, which did not result in a significant difference in either treatment group. At 6-month follow-up differences in rhythm outcome were even smaller between the both groups. These findings suggest that microwave ablation surgery does not significantly induce SR conversion.
Health-related quality of life showed an overall linear enhancement after cardiac surgery: indeed there was a steady gradual improvement in resumption of activities and a gradual diminishing of physical symptoms.This finding confirms traditional expectations of recovery following surgery. In contrast to cardiac surgery, additional ablation surgery did not affect QoL. Since rhythm outcome also did not significantly differ between treatment groups, we could not actually demonstrate that induced SR does not affect HrQoL. To investigate whether overall improvement in QoL in both treatment groups was due to treatment of underlying heart disease by cardiac surgery itself or due to SR conversion further larger studies are necessary to confirm our findings.
192