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Sari D. Holmes - One of the best experts on this subject based on the ideXlab platform.
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Early Stable Sinus Rhythm Associated With Greater Success 5 Years After Surgical Ablation.
The Annals of thoracic surgery, 2018Co-Authors: Sari D. HolmesAbstract:Background An important challenge in Surgical Ablation for atrial fibrillation (AF) is the scarcity of publications on credible predictors of long-term success in procedures performed with Ablation tools that produce consistently reliable transmural lesions. We examined factors associated with 1-year success and no atrial arrhythmia (AA) recurrence during 1 to 5 years after Surgical Ablation for AF. Methods The study prospectively monitored 743 Surgical Ablation patients with complete rhythm follow-up at 12 months after the operation. No detected AA was defined as no known recurrence of AA, no cardioversions, and no catheter Ablations at all available follow-up assessments. Results Patients were a mean age of 64.7 years, and 32% were women. Patients with no detected AA during the first year after Surgical Ablation were more likely to maintain sinus rhythm without recurrence during 1 to 5 years (74% vs 28%, p p p p = 0.043), whereas older age (OR, 1.03; p p = 0.043) were associated with greater risk for AA recurrence. Conclusions Most patients with no detected AA throughout the first 12 months after Surgical Ablation continued to be recurrence free for 5 years. Younger age, shorter preoperative AF duration, and greater surgeon experience may be associated with more persistent Surgical correction of AF.
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The Need for Consistent Predictors of Success for Surgical Ablation of Atrial Fibrillation: A Call to Action.
Innovations (Philadelphia Pa.), 2017Co-Authors: Sari D. Holmes, Jay Patel, Deborah J. ShumanAbstract:ObjectiveAs with any medical therapy, identification of consistent and reliable outcome predictors is essential to understanding the efficacy of Surgical Ablation for atrial fibrillation. We origin...
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Amiodarone after Surgical Ablation for atrial fibrillation: Is it really necessary? A prospective randomized controlled trial.
The Journal of thoracic and cardiovascular surgery, 2015Co-Authors: Sari D. Holmes, Deborah J. Shuman, Graciela Pritchard, Casey E. MillerAbstract:Abstract Objective Prophylactic antiarrhythmic drug (AAD) treatment is a well-established practice after catheter Ablation for atrial fibrillation (AF), but it is controversial after Surgical Ablation. This prospective randomized controlled trial examined whether amiodarone after Surgical Ablation reduced atrial arrhythmia recurrence within the first 3 months after surgery. Methods Ninety patients were randomized to receive (n = 45) or not receive (n = 45) amiodarone after Surgical Ablation. Rhythm status was ascertained via clinical follow-up and 72-hour continuous monitoring at 6 and 12 weeks, using Heart Rhythm Society guidelines. Primary outcome was defined as atrial arrhythmia recurrence, cardioversion, Ablation, or crossover from no-amiodarone to amiodarone as a result of atrial arrhythmia during follow-up. An intention-to-treat approach was used. Results The 2 study groups were similar in traditional predictors for failure, including left atrium size (5.0 vs 5.1 cm, P = .734), median AF duration (23 vs 20 months, P = .513), and long-standing persistent AF (44% vs 33%, P = .280). The primary outcome occurred in 52% of the no-amiodarone group (23 of 44) and 19% of the amiodarone group (8 of 43; P = .001). Cumulative freedom from primary outcome was greater in the amiodarone group (81.4% vs 47.7%, P Conclusions Prophylactic amiodarone reduced early atrial arrhythmia recurrence. These results are consistent with catheter AF Ablation findings and should inform recommendations for prophylactic class I/III AAD after Surgical AF Ablation, regardless of discharge rhythm status. As previously recommended, monitoring for side effects and amiodarone discontinuation by 3 months, for patients in sinus rhythm, is warranted. Clinical Trial Registration NCT01416935.
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Should Surgical Ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium
The Journal of thoracic and cardiovascular surgery, 2013Co-Authors: Linda Henry, Sharon A. Hunt, Sari D. HolmesAbstract:Objective One established predictor for failure of Surgical Ablation for atrial fibrillation is increased left atrial size. Surgeon perception is that Surgical Ablation in these patients is ineffective and should not be performed. The purpose of this study was to determine whether a larger left atrial size carries a prohibitive risk for failure and embolic events after Surgical Ablation. Methods In patients undergoing Surgical Ablation without left atrial reduction (N = 373), left atrial size was measured via transthoracic echocardiography within 6 months before surgery. Large (>5.5 cm; n = 83) and small (≤5.5 cm; n = 290) left atrial size groups were compared on outcomes. Results Patients in the large left atrium group were younger ( P = .02) and had lower operative risk (European System for Cardiac Operative Risk Evaluation, P = .01), but they were not different in type ( P = .51) or duration of atrial fibrillation ( P = .93). The large left atrium group was less likely to be in sinus rhythm at 1 year (86% vs 93%, P = .04), but there was no difference in sinus rhythm without antiarrhythmic drugs (77% vs 85%, P = .10). By 2 years, the large and small left atrium groups were similar in sinus rhythm (85% vs 90%, P = .35). Freedom from embolic stroke was similar ( P = .70) despite the majority of patients not taking anticoagulation at 1 year. Conclusions The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-Ablation, left atrial size should not be a discouragement when evaluating Surgical candidates with atrial fibrillation.
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The state of Surgical Ablation for atrial fibrillation in patients with mitral valve disease
Current opinion in cardiology, 2013Co-Authors: Linda Henry, Paul S. Massimiano, Grace Pritchard, Sari D. HolmesAbstract:PURPOSE OF REVIEW Atrial fibrillation has been shown to be associated with less favorable short and long-term outcomes in patients having mitral valve surgery. Despite the growing evidence related to the potential benefits of Surgical Ablation for atrial fibrillation at the time of the mitral valve operation, there is a significant variability among surgeons in their approaches to atrial fibrillation. The purpose of this review is to discuss the current state of Surgical Ablation for atrial fibrillation as reported in the literature, as well as to discuss the significance of atrial fibrillation and the different Surgical approaches to treat patients with mitral valve disease who may also concurrently suffer from tricuspid valve disease and atrial fibrillation. RECENT FINDINGS Increased mortality and morbidity are expected when atrial fibrillation is left untreated in patients undergoing mitral valve surgery. Modern Surgical Ablations resulted in a shift from the cut and sew maze procedure to the vast majority of cases being performed using different Ablation technologies. The use of Ablation technology simplifies the procedure. The expectation is that the vast majority of patients with atrial fibrillation will be ablated at the time of their mitral valve surgery. SUMMARY Patients who have mitral valve with or without tricuspid valve disease with a significant history of atrial fibrillation may benefit from Surgical Ablation to eliminate atrial fibrillation. No increased perioperative morbidity or mortality has been documented with an improved long-term survival and very low incidence of thromboembolic events.
Linda Henry - One of the best experts on this subject based on the ideXlab platform.
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Should Surgical Ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium
The Journal of thoracic and cardiovascular surgery, 2013Co-Authors: Linda Henry, Sharon A. Hunt, Sari D. HolmesAbstract:Objective One established predictor for failure of Surgical Ablation for atrial fibrillation is increased left atrial size. Surgeon perception is that Surgical Ablation in these patients is ineffective and should not be performed. The purpose of this study was to determine whether a larger left atrial size carries a prohibitive risk for failure and embolic events after Surgical Ablation. Methods In patients undergoing Surgical Ablation without left atrial reduction (N = 373), left atrial size was measured via transthoracic echocardiography within 6 months before surgery. Large (>5.5 cm; n = 83) and small (≤5.5 cm; n = 290) left atrial size groups were compared on outcomes. Results Patients in the large left atrium group were younger ( P = .02) and had lower operative risk (European System for Cardiac Operative Risk Evaluation, P = .01), but they were not different in type ( P = .51) or duration of atrial fibrillation ( P = .93). The large left atrium group was less likely to be in sinus rhythm at 1 year (86% vs 93%, P = .04), but there was no difference in sinus rhythm without antiarrhythmic drugs (77% vs 85%, P = .10). By 2 years, the large and small left atrium groups were similar in sinus rhythm (85% vs 90%, P = .35). Freedom from embolic stroke was similar ( P = .70) despite the majority of patients not taking anticoagulation at 1 year. Conclusions The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-Ablation, left atrial size should not be a discouragement when evaluating Surgical candidates with atrial fibrillation.
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The state of Surgical Ablation for atrial fibrillation in patients with mitral valve disease
Current opinion in cardiology, 2013Co-Authors: Linda Henry, Paul S. Massimiano, Grace Pritchard, Sari D. HolmesAbstract:PURPOSE OF REVIEW Atrial fibrillation has been shown to be associated with less favorable short and long-term outcomes in patients having mitral valve surgery. Despite the growing evidence related to the potential benefits of Surgical Ablation for atrial fibrillation at the time of the mitral valve operation, there is a significant variability among surgeons in their approaches to atrial fibrillation. The purpose of this review is to discuss the current state of Surgical Ablation for atrial fibrillation as reported in the literature, as well as to discuss the significance of atrial fibrillation and the different Surgical approaches to treat patients with mitral valve disease who may also concurrently suffer from tricuspid valve disease and atrial fibrillation. RECENT FINDINGS Increased mortality and morbidity are expected when atrial fibrillation is left untreated in patients undergoing mitral valve surgery. Modern Surgical Ablations resulted in a shift from the cut and sew maze procedure to the vast majority of cases being performed using different Ablation technologies. The use of Ablation technology simplifies the procedure. The expectation is that the vast majority of patients with atrial fibrillation will be ablated at the time of their mitral valve surgery. SUMMARY Patients who have mitral valve with or without tricuspid valve disease with a significant history of atrial fibrillation may benefit from Surgical Ablation to eliminate atrial fibrillation. No increased perioperative morbidity or mortality has been documented with an improved long-term survival and very low incidence of thromboembolic events.
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Surgical Ablation of atrial fibrillation trends and outcomes in North America
The Journal of thoracic and cardiovascular surgery, 2012Co-Authors: Rakesh M. Suri, James S. Gammie, Shubin Sheng, Sean M. O'brien, Linda HenryAbstract:Objective Despite growing awareness of the clinical significance of atrial fibrillation (AF) and observational data demonstrating the safety and efficacy of Surgical therapy, AF Ablation is variably performed among patients with AF undergoing cardiac surgery. We examined the national trends of Surgical Ablation and perioperative outcomes for stand-alone Surgical Ablation of AF. Methods Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, 91,801 (2005-2010) Surgical AF Ablations were performed of which 4893 (5.3%) were stand-alone procedures. The outcomes of 854 propensity-matched pairs having "on" versus "off" cardiopulmonary bypass stand-alone Ablation were compared. Results The percentage of patients with preoperative AF increased from 2005 to 2010 (from 10.0% to 12.2%). Overall, 40.6% of patients with AF underwent concomitant Surgical Ablation—a significant decline of 1.6% from 2005 to 2010. The number of stand-alone Surgical Ablations increased significantly from 552 to 1041 cases (2005-2010). Overall, the stand-alone group had a mean age of 60 years, 71% were men, and 80% were treated "off" cardiopulmonary bypass. The "on" cardiopulmonary bypass group had significantly more pulmonary disease, diabetes, and congestive heart failure. Overall, the operative mortality and stroke rate was 0.7% for each. After propensity matching, the "off" cardiopulmonary bypass group underwent significantly fewer reoperations for bleeding and had a lower incidence of prolonged ventilation and shorter hospitalization. New pacemaker implantation was low, without group differences. Conclusions The prevalence of AF in patients undergoing cardiac surgery has increased, as has the number of stand-alone Surgical Ablations. The treatment of concomitant disease declined slightly. Isolated Surgical Ablation is safe, performed "on" or "off" cardiopulmonary bypass. These results support consideration of Surgical AF Ablation as an alternative to percutaneous Ablation for patients with lone AF.
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The impact of Surgical Ablation for atrial fibrillation in high-risk patients.
The Annals of thoracic surgery, 2012Co-Authors: Linda Henry, Sari D. Holmes, Sharon L. HuntAbstract:Background Data reported by The Society of Thoracic Surgeons adult cardiac surgery database demonstrate that only 38% of patients with atrial fibrillation (AF) underwent a concomitant Surgical Ablation. Surgeons are reluctant to add complexity and potential morbidity by including an additional procedure when performing surgery in higher operative risk patients. We investigated perioperative and long-term outcomes in high-risk patients who underwent open heart surgery with or without Surgical Ablation for AF. Methods An additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) higher than 6 defined high-risk patients. Perioperative outcomes were captured prospectively, and long-term survival and quality of life were assessed. Propensity score matching using a 0.25 caliper was conducted between the Surgical Ablation group and the nonAblation group (no history of AF). Results The propensity score matching analysis included 178 patients per group. The groups were similar on preoperative characteristics including age, ejection fraction, EuroSCORE, and Surgical procedures. The perioperative outcomes were similar between groups, including length of stay, permanent stroke, renal failure, 30-day readmissions, and operative ( Conclusions The addition of an AF Surgical Ablation procedure did not add operative risk to patients considered high risk, and potentially improved long-term outcome for the subgroup of patients who had their AF ablated. This study suggests that the degree of Surgical risk should not be the only decision factor when evaluating this challenging group of patients for Surgical Ablation.
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the impact of Surgical Ablation in patients with low ejection fraction heart failure and atrial fibrillation
European Journal of Cardio-Thoracic Surgery, 2011Co-Authors: Linda Henry, Sharon A. HuntAbstract:Objective: SurgicalAblationproceduresthatusetheCox-Mazeprocedurelesionsetwereshowntobeveryeffective.However,manysurgeonsare reluctanttoperformtheprocedure,especiallyinhigh-riskpatientssuchasthosewithreducedleftventricular(LV)function.Thisstudyexploredthe potentialimpactoftheCox-MazeIII/IVprocedureonpatientswithlowejectionfraction(EF < 40%)andsymptomsofheartfailureexperiencingatrial fibrillation (AF) who present for cardiac surgery. Methods:A prospective study whereby patients with persistent or long-standing persistent AF who had Surgical Ablation were followed. Echocardiograms (echo) were obtained; patients with preoperative EF <40% were included. Health-related qualityoflife(HRQL-SF-12)andAFsymptomseveritywereobtainedatbaselineandfollow-up.Rhythmwascapturedbyelectrocardiogram(EKG)and 24-h Holter. Results: In the past 5 years, 482 patients had Surgical Ablation (424 full Cox-Maze) of whom 44 patients met the inclusion criteria; however, two patients did not have an available follow-up echo, leaving 42 patients for analysis. Mean age was 61.1 12.9 years, and additive EuropeanSystemforCardiacOperativeRiskEvaluation(EuroSCORE)of7.5 3.1.Therewasoneoperativedeath,therewerenostrokesortransient ischemic attacks (TIAs) at follow-up, and EF improved from 30 5.0% to 45 13.0% at a mean of 1.5 11.3months, postoperatively. The return to NSR at time of follow-up echo was 86% (35/40). The physical functioning HRQL scores improved (37.0 12.3 to 46.8 9.1, p = 0.02) at 12 months (population norm = 38.1 9.9) with a significant improvement in symptom severity. Kaplan—Meier event-free survival at 24 months was 87% (confidence interval (CI): 80.4—91.6) (events considered were redo valve replacement, ventricular assist device or death). Conclusions: This is a unique study assessing a high-risk group of patients. Surgical Ablation in patients with low EF can be performed in a safe and effective way without addedoperativerisk.Giventhepotentiallong-termclinicaladvantagesofasuccessfulSurgicalAblationinpatientswithlowEFandheartfailure,we
Ralph J. Damiano - One of the best experts on this subject based on the ideXlab platform.
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Surgical Ablation of Atrial Fibrillation in Patients with Heart Failure
The Journal of thoracic and cardiovascular surgery, 2020Co-Authors: Ali J. Khiabani, Richard B. Schuessler, Ralph J. DamianoAbstract:Abstract Both congestive heart failure (HF) and atrial fibrillation (AF) are important and increasingly common forms of cardiovascular disease in the 21st century. Heart failure is often complicated by AF, and AF can exacerbate and, in some cases, cause HF, also known as tachycardia-induced cardiomyopathy (TIC). Restoration and maintenance of sinus rhythm in the majority of AF patients with TIC can lead to an improvement in left ventricular function and dramatic symptomatic relief. This can be accomplished by Surgical Ablation; specifically, the Cox-Maze IV procedure (CMP IV), in those refractory to medical and catheter-based Ablation, and those patients undergoing concomitant cardiac operation. However, many surgeons are reluctant to perform stand-alone or concomitant CMP IV in this high-risk cohort of patients. In this review, the over three decades of experience with Surgical Ablation will be reviewed along with the essential information that surgeons need to be aware of as they participate in the team-based care of patients with AF and HF.
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Massive Left Atrial Thrombus After a Left Atrial Surgical Ablation and Bioprosthetic Mitral Valve Replacement.
Innovations (Philadelphia Pa.), 2020Co-Authors: Mustafa Husaini, Ralph J. Damiano, Nishath Quader, Alan C. Braverman, Hersh S. ManiarAbstract:Variability exists regarding the timing and duration of anticoagulation after Surgical Ablation for atrial fibrillation and bioprosthetic mitral valve replacement (MVR). We report a case in which a...
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Surgical Ablation of Atrial Fibrillation in Patients With Tachycardia-Induced Cardiomyopathy.
The Annals of thoracic surgery, 2019Co-Authors: Taylan Adademir, Matthew R. Schill, Richard B. Schuessler, Ali J. Khiabani, Laurie A. Sinn, Marc R. Moon, Spencer J. Melby, Ralph J. DamianoAbstract:Background Atrial fibrillation (AF) is a common cause of tachycardia-induced cardiomyopathy (TIC). This study evaluated the outcomes of the Cox-Maze IV procedure in patients with TIC and significant left ventricular dysfunction. Methods Between January 2002 and January 2017, 37 consecutive patients with a left ventricular ejection fraction (LVEF) of 0.40 or less underwent stand-alone Surgical Ablation of AF. After dilated and ischemic cardiomyopathies were excluded, 34 of 37 patients met the criteria for the diagnosis of TIC. Results Patients were a mean age of 56 ± 11 years, and 24 (70%) had long-standing persistent AF. The median AF duration was 72 months (interquartile range, 9 to 276 months). Seventeen patients (50%) had at least one catheter-based Ablation that failed. Mean LVEF was 0.32 ± 0.08. There were 11 patients (32%) with New York Heart Association Functional Classification III/IV symptoms. There was one (3%) 30-day mortality caused by a pulmonary embolus, despite full anticoagulation. At 12 months, freedom from atrial tachyarrhythmias on or off antiarrhythmic drugs was 94% and 89%, respectively. Postoperative echocardiograms were available for 27 of 33 patients (82%). The LVEF improved to a mean of 0.55 ± 0.08 (95% confidence interval, 0.51 to 0.58; p Conclusions Restoration of sinus rhythm with the Cox-Maze IV was associated with significant improvement in the LVEF in patients with AF and TIC. This retrospective study illustrates the efficacy of the Cox-Maze IV in this patient population both at restoring sinus rhythm and improving ventricular function. Patients with TIC and poor left ventricular function in whom other treatments have failed should be strongly considered for Surgical Ablation.
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ESC CardioMed - Rhythm control: Surgical Ablation
ESC CardioMed, 2018Co-Authors: Chawannuch Ruaengsri, Matthew R. Schill, Richard B. Schuessler, Ralph J. DamianoAbstract:Surgical Ablation for atrial fibrillation was introduced in 1987 and has since become well established as a treatment option for patients with symptomatic atrial fibrillation refractory to antiarrhythmic drugs and/or catheter Ablation or patients who are having concomitant cardiac Surgical procedures. The Cox–Maze procedure has been improved upon by modern variations using Ablation devices. More limited Ablation procedures and hybrid procedures have been introduced, but their efficacy requires further investigation.
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Effectiveness of Surgical Ablation in Patients With Atrial Fibrillation and Aortic Valve Disease
The Annals of thoracic surgery, 2015Co-Authors: Matthew C. Henn, Christopher P. Lawrance, Richard B. Schuessler, Laurie A. Sinn, Hersh S. Maniar, Marc R. Moon, Spencer J. Melby, Jacob R. Miller, Ralph J. DamianoAbstract:Background In patients with atrial fibrillation (AF), the addition of Surgical Ablation to aortic valve replacement (AVR) does not increase procedural morbidity or mortality. However, efficacy in this population has not been carefully evaluated. This study compared outcomes between patients undergoing stand-alone Cox-Maze IV with those undergoing Surgical Ablation and concomitant AVR. Methods From January 2002 to May 2014, 188 patients received a stand-alone Cox-Maze IV (n = 113) or Surgical Ablation with concomitant AVR (n = 75). In the concomitant AVR group, patients underwent Cox-Maze IV (n = 58), left-sided Cox-Maze IV (n = 3), or pulmonary vein isolation (n = 14). Thirty-one perioperative variables were compared. Freedoms from AF on and off antiarrhythmic drugs were evaluated at 3, 6, 12, and 24 months. Results Follow-up was available in 97% of patients. Freedom from AF on and off antiarrhythmic drugs in patients receiving a stand-alone Cox-Maze IV versus concomitant AVR was not significantly different at any time point. The concomitant AVR group had more comorbidities, paroxysmal AF, pacemaker implantations (24% vs 5%, p = 0.002), and complications (25% vs 5%, p p = 0.001). Conclusions A Cox-Maze IV with concomitant AVR is as effective as a stand-alone Cox-Maze IV in treating AF, even in an older population with more comorbidities. Pulmonary vein isolation was not as effective and is not recommended in this population. A Cox-Maze IV should be considered in all patients undergoing AVR with a history of AF.
Vidal Essebag - One of the best experts on this subject based on the ideXlab platform.
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Monomorphic Ventricular Tachycardia 25 Years Post Surgical Ablation for Wolff–Parkinson–White
The Canadian journal of cardiology, 2012Co-Authors: Jacqueline Joza, G. Becker, Pierre Pagé, Vidal EssebagAbstract:Abstract The first Surgical Ablation of an accessory pathway for the treatment of Wolff–Parkinson–White (WPW) syndrome was performed in 1968, and surgery remained first-line therapy until the advent of catheter Ablation techniques in the early 1990s. Current indications for Surgical Ablation of WPW syndrome are limited to Ablation failures. To this day, there has been no long-term follow-up of these Surgically treated patients. We describe the case of a man, aged 54 years, who developed ventricular tachycardia 25 years after Surgical Ablation of WPW. This is first reported case of ventricular tachycardia following an epicardial Surgical cryoAblation technique for WPW.
Hersh S. Maniar - One of the best experts on this subject based on the ideXlab platform.
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Massive Left Atrial Thrombus After a Left Atrial Surgical Ablation and Bioprosthetic Mitral Valve Replacement.
Innovations (Philadelphia Pa.), 2020Co-Authors: Mustafa Husaini, Ralph J. Damiano, Nishath Quader, Alan C. Braverman, Hersh S. ManiarAbstract:Variability exists regarding the timing and duration of anticoagulation after Surgical Ablation for atrial fibrillation and bioprosthetic mitral valve replacement (MVR). We report a case in which a...
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Impact of age on atrial fibrillation recurrence following Surgical Ablation.
The Journal of thoracic and cardiovascular surgery, 2020Co-Authors: Robert M. Macgregor, Richard B. Schuessler, Ali J. Khiabani, Nadia H. Bakir, Joshua L. Manghelli, Laurie A. Sinn, Daniel I. Carter, Hersh S. Maniar, Marc R. Moon, Spencer J. MelbyAbstract:Abstract Objectives The incidence of atrial fibrillation (AF) in patients older than 75 years of age is expected to increase, and its treatment remains challenging. This study evaluated the impact of age on the outcomes of Surgical Ablation of AF. Methods A retrospective review was performed of patients who underwent the Cox-maze IV procedure at a single institution between 2005 and 2017. The patients were divided into a younger (age Results The mean age of the elderly group was 78.5 ± 2.8 years. The majority of patients (423/696, 61%) had nonparoxysmal AF. The elderly patients had a lower body mass index (P Conclusions The efficacy of the Cox-maze IV procedure was worse in elderly patients; however, the majority of patients remained free of ATAs at 5 years. The lower success rate in these greater-risk patients should be considered when deciding to perform Surgical Ablation.
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Postoperative medication management after Surgical Ablation: Clarifying the role of amiodarone therapy.
The Journal of thoracic and cardiovascular surgery, 2015Co-Authors: Hersh S. Maniar, Eric NovakAbstract:The investigation in this issue of the Journal by Ad and colleagues 1 iswelldesigned, isclearlywritten,andprovides information that is helpful to surgeons performing Surgical Ablation for atrial fibrillation (AF). The field of Surgical Ablation has had difficulty in establishing helpful guidelines for surgeons because of the wide variety of techniques used to perform the Ablations and the variability that exists in the follow-up and management of these patients. 2,3 Ad and colleagues 1 are to be commended for trying to address the postoperativemanagement ofthesepatientsandspecifically the role of amiodarone therapy. The results of this investigation fit nicely with the recently published randomized trial The Effect of Short Term Amiodarone Treatment After Catheter Ablation for Atrial Fibrillation (AMIO-CAT), which investigated the use of amiodarone after endocardial Ablation. 4 And although there are limitations in directly applying results obtained after a percutaneous, endocardial Ablation to those of a Surgical Cox maze procedure, both studies have similarly documented significantly fewer postAblation AF or atrial tachycardia recurrences during the 3-month blanking period in patients receiving amiodarone therapy. This study by Ad and colleagues 1 was neither designed nor powered to address secondary clinical end points, but future investigations should address the additional findings of AMIO-CAT that demonstrated that amiodarone use, when clinically tolerated by patients, had the ability to significantly reduce postAblation rehospitalizations and cardioversions for several months after the procedure. The potential benefit of reduced readmissions after cardiac surgery, if realized, will likely be sufficient in and of itself to justify postoperative amiodarone therapy within the Surgical Ablation population. 5
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Effectiveness of Surgical Ablation in Patients With Atrial Fibrillation and Aortic Valve Disease
The Annals of thoracic surgery, 2015Co-Authors: Matthew C. Henn, Christopher P. Lawrance, Richard B. Schuessler, Laurie A. Sinn, Hersh S. Maniar, Marc R. Moon, Spencer J. Melby, Jacob R. Miller, Ralph J. DamianoAbstract:Background In patients with atrial fibrillation (AF), the addition of Surgical Ablation to aortic valve replacement (AVR) does not increase procedural morbidity or mortality. However, efficacy in this population has not been carefully evaluated. This study compared outcomes between patients undergoing stand-alone Cox-Maze IV with those undergoing Surgical Ablation and concomitant AVR. Methods From January 2002 to May 2014, 188 patients received a stand-alone Cox-Maze IV (n = 113) or Surgical Ablation with concomitant AVR (n = 75). In the concomitant AVR group, patients underwent Cox-Maze IV (n = 58), left-sided Cox-Maze IV (n = 3), or pulmonary vein isolation (n = 14). Thirty-one perioperative variables were compared. Freedoms from AF on and off antiarrhythmic drugs were evaluated at 3, 6, 12, and 24 months. Results Follow-up was available in 97% of patients. Freedom from AF on and off antiarrhythmic drugs in patients receiving a stand-alone Cox-Maze IV versus concomitant AVR was not significantly different at any time point. The concomitant AVR group had more comorbidities, paroxysmal AF, pacemaker implantations (24% vs 5%, p = 0.002), and complications (25% vs 5%, p p = 0.001). Conclusions A Cox-Maze IV with concomitant AVR is as effective as a stand-alone Cox-Maze IV in treating AF, even in an older population with more comorbidities. Pulmonary vein isolation was not as effective and is not recommended in this population. A Cox-Maze IV should be considered in all patients undergoing AVR with a history of AF.