Page 96 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Addendum
Summary
In the present thesis, drivers for add-on ablation surgery in atrial fibrillation (AF) are investigated.
AF is the most prevalent cardiac arrhythmia in the Western world and is characterized by uncoordinated and rapid activation of the atria. Its prevalence increases with advancing age and has been projected to increase to 1 million in The Netherlands in 2050, thus increasingly placing a burden on our (financial) health care resources.
AF may occur in self-limiting episodes lasting from minutes to days (paroxysmal AF) or may be permanent in nature (persistent or permanent AF). It coincides with significant clinical morbidity and is also an independent risk factor for mortality. Ischaemic heart disease, cardiac failure, valvular heart disease, hypertension, diabetes, alcohol abuse, thyroid disorders, anxiety and depression and pulmonary disease are often found in AF patients. Due to the uncoordinated and rapid activation of the atria in AF patients, atrial blood flow diminishes and can cause thromboembolisms.Thromboembolic stroke is the most serious and debilitating of all the complications of AF.
AF is common in patients who undergo valvular and/or coronary bypass surgery, dependant on underlying heart disease and age. Nonetheless, in a percentage of non-eligible people presenting with AF, there is no identifiable aetiology and this subset of patients is often referred to as ‘lone AF’ (LAF).
Because of its multiple manifestations and concomitant diseases,AF management can be quite complicated. Historically, long-term treatment for AF consists of rate versus rhythm control. Randomised trials have shown an almost significant trend towards reduced morbidity, mortality and stroke by rate control, but this may have been due to inadequate anticoagulation among patients in whom AF seemed to be controlled with antiarrhythmic drugs.Two drawbacks for treatment with antiarrhythmic drugs in the maintenance of sinus rhythm (SR) are inconsistent efficacy and severe side effects. Furthermore, SR is difficult to obtain. As a large group of patients show severe and frequent symptoms of AF (despite the use of many antiarrhythmic and rate control drugs) while being at great risk for systemic embolization, non-pharmacological approaches in the treatment of AF have gained increased interest in the last few years.
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