Page 98 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Addendum
never been investigated if additional indications for OAC are present within the AF patient population. In other words, should OAC 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.
As mentioned before, the burden of AF on our (financial) health care resources is high and will become even higher in the next decades due to the general aging and growing of our Dutch population.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.
Nonetheless, there are still also many aspects of add-on ablation surgery that have been poorly investigated. Controversy exists as to whether the considerable proportion of health care resources spent on add-on surgery in AF represents a cost-effective approach in an attempt to maintain a meaningful QoL and if QoL is affected by the restoration of SR.
Furthermore, electrical cardioversion (ECV) is commonly recommended for patients with recurrent AF following an initial ablation procedure. Nonetheless, although the long-term effect of ECV might be promising under these circumstances, it has been reported that a large number of patients who undergo ECV for persistent AF or atrial flutter after ablation surgery have AF recurrences. However, little is known about the benefit of ECV, with or without additional pharmacological pre-treatment, after unsuccessful add-on ablation surgery. Moreover, the current management of OAC therapy following add-on ablation surgery is unknown and no guidelines were put in place until recently. Moreover little work has been done to investigate the best anticoagulation treatment strategies after surgical ablation. 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 defined.
Chapter 2 describes the effect of add-on ablation surgery on HrQoL in AF patients. During 1-year follow-up HrQOL showed an overall linear enhancement after cardiac surgery, this was irrespective of whether add-on ablation surgery
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