Kevin Phan1, Ashleigh Xie1, David H Tian1, Kasra Shaikhrezai2, Tristan D Yan3. 1. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; ; Golden Jubilee National Hospital, Glasgow, United Kingdom ; 3. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: Surgical ablation has emerged as an acceptable treatment modality for patients with atrial fibrillation (AF) undertaking concomitant cardiac surgery. However, the efficacy of surgical ablation in patient populations undergoing mitral valve surgery is not well established. The present meta-analysis aims to establish the current randomized evidence on clinical outcomes of surgical ablation versus no ablative treatment in patients with AF undergoing mitral valve surgery. METHODS: Electronic searches were performed using six databases from their inception to September 2013, identifying all relevant randomized controlled trials (RCTs) comparing surgical ablation versus no ablation in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Nine relevant RCTs were identified for inclusion in the present analysis. The number of patients in sinus rhythm (SR) was significantly improved in the surgical ablation group compared to the non-ablation group at discharge. This effect on SR remained at all follow-up periods until >1 year. Results indicated that there was no significant difference between surgical ablation and no ablation in terms of 30-day mortality, all-cause mortality, pacemaker implantation, stroke, thromboembolism, cardiac tamponade, reoperation for bleeding and myocardial infarction. CONCLUSIONS: Results from the present meta-analysis demonstrate that the addition of surgical ablation for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke and thromboembolism. Further research should be directed at correlating different surgical ablation subtypes to cardiac and cerebrovascular events at long-term follow-up.
BACKGROUND: Surgical ablation has emerged as an acceptable treatment modality for patients with atrial fibrillation (AF) undertaking concomitant cardiac surgery. However, the efficacy of surgical ablation in patient populations undergoing mitral valve surgery is not well established. The present meta-analysis aims to establish the current randomized evidence on clinical outcomes of surgical ablation versus no ablative treatment in patients with AF undergoing mitral valve surgery. METHODS: Electronic searches were performed using six databases from their inception to September 2013, identifying all relevant randomized controlled trials (RCTs) comparing surgical ablation versus no ablation in AFpatients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Nine relevant RCTs were identified for inclusion in the present analysis. The number of patients in sinus rhythm (SR) was significantly improved in the surgical ablation group compared to the non-ablation group at discharge. This effect on SR remained at all follow-up periods until >1 year. Results indicated that there was no significant difference between surgical ablation and no ablation in terms of 30-day mortality, all-cause mortality, pacemaker implantation, stroke, thromboembolism, cardiac tamponade, reoperation for bleeding and myocardial infarction. CONCLUSIONS: Results from the present meta-analysis demonstrate that the addition of surgical ablation for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke and thromboembolism. Further research should be directed at correlating different surgical ablation subtypes to cardiac and cerebrovascular events at long-term follow-up.
Entities:
Keywords:
Maze; Surgical ablation; atrial fibrillation; meta-analysis; mitral valve surgery
Authors: T Deneke; K Khargi; P H Grewe; A Laczkovics; S von Dryander; T Lawo; K-M Müller; B Lemke Journal: Eur Heart J Date: 2002-04 Impact factor: 29.983
Authors: Sunil M Prasad; Hersh S Maniar; Cindy J Camillo; Richard B Schuessler; John P Boineau; Thoralf M Sundt; James L Cox; Ralph J Damiano Journal: J Thorac Cardiovasc Surg Date: 2003-12 Impact factor: 5.209
Authors: Davy C H Cheng; Niv Ad; Janet Martin; Eva E Berglin; Byung-Chul Chang; George Doukas; James S Gammie; Takashi Nitta; Randall K Wolf; John D Puskas Journal: Innovations (Phila) Date: 2010-03
Authors: Mark D Huffman; Kunal N Karmali; Mark A Berendsen; Adin-Cristian Andrei; Jane Kruse; Patrick M McCarthy; S C Malaisrie Journal: Cochrane Database Syst Rev Date: 2016-08-22