Ivo K Genev1, Lindsey A Tompkins2, Manorama M Khare3, Farhad Farokhi1. 1. Department of Cardiac Electrophysiology, UIC College of Medicine at Rockford and the Rockford Cardiovascular Associates OSF Healthcare, Rockford, IL, USA. 2. Department of Biomedical Science, UIC College of Medicine at Rockford and the Rockford Cardiovascular Associates OSF Healthcare, Rockford, IL, USA. 3. Department of Family and Community Medicine, Division of Health Policy and Social Science Research, UIC College of Medicine at Rockford, Rockford, Illinois, USA.
Abstract
INTRODUCTION: Atrial fibrillation is the most common cardiac arrhythmia in the United States. It has been associated with a reduction in patient quality of life and more serious complications such as stroke and heart failure. The aim of this study was to compare the efficacy of commonly performed invasive procedures in keeping patients in normal sinus rhythm. METHODS AND RESULTS: A retrospective chart review was performed on all patients who underwent primary radiofrequency catheter ablation, the complete Cox-maze, or the hybrid maze at OSF Saint Anthony Medical Center between January 2010 and December 2013 (n=140). Immediately post-procedure, arrhythmia recurrence rates did not differ between the groups (p = 0.28). At all follow-up points thereafter, however, differences in procedural efficacy between surgical and catheter therapy remained highly significant (p < 0.001). At 2 years, 20.3% of the catheter ablation patients were in normal sinus rhythm, when compared to 57.9% of hybrid maze and 72.7% the complete Cox-maze groups. A difference in major complication rates was noted (p = 0.04), with the complete Cox-maze having a 17.4%, the hybrid having 22.7%, and the catheter ablation group having 5.6%. CONCLUSIONS: This study was unable to detect differences in the efficacy rates of the surgical procedures, however they were both superior to catheter ablation. Although the hybrid approach is considered minimally invasive, complication rates were similar to those of the complete Cox-maze. Catheter ablation was the safest procedure, and since evidence of reduced mortality after the use of aggressive rhythm therapy is currently lacking, the results suggest that hybrid surgery for atrial fibrillation should be used after the failure of more conservative measures.
INTRODUCTION: Atrial fibrillation is the most common cardiac arrhythmia in the United States. It has been associated with a reduction in patient quality of life and more serious complications such as stroke and heart failure. The aim of this study was to compare the efficacy of commonly performed invasive procedures in keeping patients in normal sinus rhythm. METHODS AND RESULTS: A retrospective chart review was performed on all patients who underwent primary radiofrequency catheter ablation, the complete Cox-maze, or the hybrid maze at OSF Saint Anthony Medical Center between January 2010 and December 2013 (n=140). Immediately post-procedure, arrhythmia recurrence rates did not differ between the groups (p = 0.28). At all follow-up points thereafter, however, differences in procedural efficacy between surgical and catheter therapy remained highly significant (p < 0.001). At 2 years, 20.3% of the catheter ablation patients were in normal sinus rhythm, when compared to 57.9% of hybrid maze and 72.7% the complete Cox-maze groups. A difference in major complication rates was noted (p = 0.04), with the complete Cox-maze having a 17.4%, the hybrid having 22.7%, and the catheter ablation group having 5.6%. CONCLUSIONS: This study was unable to detect differences in the efficacy rates of the surgical procedures, however they were both superior to catheter ablation. Although the hybrid approach is considered minimally invasive, complication rates were similar to those of the complete Cox-maze. Catheter ablation was the safest procedure, and since evidence of reduced mortality after the use of aggressive rhythm therapy is currently lacking, the results suggest that hybrid surgery for atrial fibrillation should be used after the failure of more conservative measures.
Authors: Lucas V A Boersma; Manuel Castella; Wimjan van Boven; Antonio Berruezo; Alaaddin Yilmaz; Mercedes Nadal; Elena Sandoval; Naiara Calvo; Josep Brugada; Johannes Kelder; Maurits Wijffels; Lluís Mont Journal: Circulation Date: 2011-11-14 Impact factor: 29.690
Authors: Hugh Calkins; Josep Brugada; Douglas L Packer; Riccardo Cappato; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; David E Haines; Michel Haissaguerre; Yoshito Iesaka; Warren Jackman; Pierre Jais; Hans Kottkamp; Karl Heinz Kuck; Bruce D Lindsay; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Andrea Natale; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Jeremy N Ruskin; Richard J Shemin Journal: Europace Date: 2007-06 Impact factor: 5.214
Authors: Mark La Meir; Sandro Gelsomino; Fabiana Lucà; Laurant Pison; Orlando Parise; Andrea Colella; Gian Franco Gensini; Harry Crijns; Francis Wellens; Jos G Maessen Journal: Int J Cardiol Date: 2012-05-02 Impact factor: 4.164
Authors: John H Rosenberg; John H Werner; Gilman D Plitt; Victoria V Noble; Jordan T Spring; Brooke A Stephens; Aleem Siddique; Helenmari L Merritt-Genore; Michael J Moulton; Devendra K Agrawal Journal: Expert Rev Cardiovasc Ther Date: 2018-12-29
Authors: Zhishan Sun; Chengming Fan; Long Song; Hao Zhang; Zenan Jiang; Haoyu Tan; Yaqin Sun; Liming Liu Journal: Front Cardiovasc Med Date: 2022-07-15
Authors: Aditya Eranki; Ashley R Wilson-Smith; Michael L Williams; Campbell D Flynn; Con Manganas Journal: J Cardiothorac Surg Date: 2022-08-13 Impact factor: 1.522
Authors: Massimiliano Marini; Luigi Pannone; Domenico G Della Rocca; Stefano Branzoli; Antonio Bisignani; Sahar Mouram; Alvise Del Monte; Cinzia Monaco; Anaïs Gauthey; Ivan Eltsov; Ingrid Overeinder; Gezim Bala; Alexandre Almorad; Erwin Ströker; Juan Sieira; Pedro Brugada; Mark La Meir; Gian-Battista Chierchia; Carlo De Asmundis; Fabrizio Guarracini Journal: J Cardiovasc Dev Dis Date: 2022-09-08