Page 99 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

was performed or not. Thus the HrQoL improvement was probably more affected by treating the underlying heart disease during surgery than by restoring sinus rhythm. But since there was no significant difference in SR restoration between the add-on surgery patient group and the regular cardiac surgery group, additional analysis was performed to investigate the effect of SR restoration on HrQoL.
Chapter 3 presents a retrospective analysis demonstrating that generic HrQoL was not influenced by SR conversion nor by possible confounders such as age, gender and type of AF. However, specific HrQoL scales are much more sensitive to SR conversion and do show significant effects and remain statistically significant after being controlled for additional confounders. In addition, the relationship between SR conversion and HrQoL (both generic and specific) tended to attenuate and wear off with postoperative time. In conclusion, the results of these two chapters with respect to HrQoL indicate that overall HrQoL in AF patients does not improve in case SR is achieved, regardless of whether this restoration was brought about by ablation surgery or the corrective effect of cardiac surgery on underlying heart disease. However, more disease-specific HrQoL questionnaires have to be used, developed and tested in clinical research to properly gauge and evaluate the effects of operation-induced SR conversion in AF patients.
Chapter 4 depicts the cost-effectiveness of add-on ablation surgery compared to isolated cardiac surgery procedures in AF patients after 1-year follow-up. To calculate the incremental cost-effectiveness ratio (ICER), the difference in costs between the two treatment options was divided by the gain in HrQoL.When the costs for both treatment modalities were compared for their effectiveness, the result was an ICER above the assumed threshold for the surgical treatment of AF. Additional ablation surgery could not be considered a cost-effective treatment in AF patients.
Chapter 5 reports the early and mid-term outcomes in patients undergoing
electrical cardioversion (ECV) for persistent AF after add-on ablation surgery (radiofrequency) in mitral valve surgery compared to patients undergoing ECV
after mitral valve surgery without concomitant AF ablation. After successful
ECV, statistically more patients in the add-on ablation group were in stable SR off-antiarrhythmic drugs, than in the no-ablation group. We can postulate that A some kind of substrate modification occurred after surgical ablation which made
the patients more susceptible to the treatment of ECV. Also the timing of the
Summar y
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