Page 97 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Multiple surgical approaches in the treatment of AF have been developed, all aimed at eliminating mechanisms in the initiation and maintenance of AF. In add- on ablation surgery, a procedure performed to treat AF during cardiac surgery where a number of incisions or ablations are made, the gold standard is still the Cox-Maze III technique, although a lot of variations have been developed over the last years. Also, new techniques such as minimally invasive catheter ablation approaches and the ‘hybrid’ procedure have gained a lot of interest over time. However, the efficacy of these procedures as well as their potential superiority over standard add-on surgical techniques has to be confirmed by large comparative studies.
In addition to purely clinical criteria such as morbidity and mortality as reasons
to treat patients with AF, enhancing health-related quality of life (HrQoL) has
gradually been accepted as another driver for AF treatment. 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, HrQoL
has become more important in health care practice and research. HrQoL in AF
patients is diminished due to palpitations, dyspnoea, dizziness, syncope, fatigue
and decreased exercise tolerance. 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
surgical techniques indeed affect quality of life, since randomised trials are lacking.
Besides enhancing HrQoL, preventing the use of oral anticoagulation (OAC) is
a key-point issue in finding a definite treatment strategy for AF. About 1 out
of 6 ischaemic strokes is associated with AF and a worse outcome is seen
than for those without AF: portraying higher mortality and morbidity, greater
disability, longer hospital stay, increased costs and higher recurrence rate. Long-
term treatment with OAC can reduce stroke risk in AF patients. Although this
mainstream therapy in reduction of stroke risk has been confirmed by multiple
trials, it is distressing to note that OAC therapy still remains widely under-utilized
in high-risk patients, insufficiently protecting them against (recurrent) stroke.
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 A 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
Summar y
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