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Cited by 76Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation

Open access
Phan, Kevin, Phan, Steven, Thiagalingam, Aravinda, Medi, Caroline, Yan, Tristan D.·2016·European Journal of Cardio-Thoracic Surgery
DOI 10.1093/ejcts/ezv180
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Abstract

For patients with atrial fibrillation (AF) who are refractory to anti-arrhythmic drugs (AADs), minimally invasive video-assisted thoracoscopic surgical ablation (SA) and catheter ablation (CA) are potential alternative treatment options. The recent FAST randomized study suggested that thoracoscopic SA was superior to CA in achieving freedom of AF in patients who have failed at least one prior AAD. To assess the relative merits and risks of SA versus CA, a systematic review and meta-analysis was conducted. Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing thoracoscopic SA and CA were identified; data were extracted and analysed according to predefined clinical endpoints. Relative risk (RR) and weighted mean difference were used as summary statistics. Freedom from AF/arrhythmias was significantly higher in SA versus CA at 12-month off-AAD (78.4 vs 53%; RR, 1.54; P < 0.0001) and on-AAD (82.6 vs 45.7%; RR, 1.85; P < 0.00001). This difference was maintained in paroxysmal and persistent AF subgroups. The SA cohort had a significantly lower requirement for repeat ablations compared with the CA cohort (4.7 vs 24.4%; RR, 0.21; P = 0.0001). However, major complications were significantly higher in the SA group (28.2 vs 7.8%; RR, 3.30; P = 0.0003), driven by pleural effusion and pneumothorax. SA may be more efficacious than CA treatment in a selected patient population with refractory AF and prior failed catheter intervention. Improved freedom from arrhythmias at up to 12-month follow-up is counterbalanced by higher procedural complication rates.

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References 39 · Cited by 76

Research works printed but not linked: 36

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 2014;129:e28-e292.
  2. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013;112:1142-7.
  3. Cox JL, Schuessler RB, Boineau JP. The development of the Maze proced- ure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000;12:2-14.
  4. Phan K, Xie A, Kumar N, Wong S, Medi C, La Meir M et al. Comparing energy sources for surgical ablation of atrial fibrillation: a Bayesian network meta-analysis of randomized, controlled trials. Eur J Cardiothorac Surg 2015;48:201-11.
  5. Phan K, Xie A, Tsai YC, Kumar N, La Meir M, Yan TD. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis. Europace 2015;17:38-47.
  6. Phan K, Xie A, La Meir M, Black D, Yan TD. Surgical ablation for treatment of atrial fibrillation in cardiac surgery: a cumulative meta-analysis of ran- domised controlled trials. Heart 2014;100:722-30.
  7. Phan K, Xie A, Tian DH, Shaikhrezai K, Yan TD. Systematic review and meta-analysis of surgical ablation for atrial fibrillation during mitral valve surgery. Ann Cardiothorac Surg 2014;3:3-14.
  8. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F et al. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol 2011;57:160-6.
  9. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.
  10. Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002;105:1077-81.
  11. Boersma LV, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation 2012;125:23-30.
  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explan- ation and elaboration. BMJ 2009;339:b2700.
  13. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C et al. Development of AMSTAR: a measurement tool to assess the methodo- logical quality of systematic reviews. BMC Med Res Method 2007;7:10.
  14. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
  15. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-63.
  16. Wang S, Liu L, Zou C. Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating parox- ysmal atrial fibrillation: a randomized, controlled short-term trial. Chin Med J 2014;127:2567-70.
  17. Rong B, Zuo C, Zeng DJ, Wen LX, Sheng MC, Hua SC et al. Catheter ablation versus mini invasive thoracoscopic surgical ablation in patients with failed prior catheter ablation for paroxysmal atrial fibrillation. Chin J Card Arrhythm 2014;18:183-88.
  18. De Maat GE, Van Gelder IC, Rienstra M, Quast AF, Tan ES, Wiesfeld AC et al. Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation: a matched group comparison. Europace 2014;16:33-9.
  19. Pokushalov E, Romanov A, Elesin D, Bogachev-Prokophiev A, Losik D, Bairamova S et al. Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: a randomized controlled trial. J Cardiovasc Electrophysiol 2013;24:1338-43.
  20. Wang J, Li Y, Shi J, Han J, Xu C, Ma C et al. Minimally invasive surgical versus catheter ablation for the long-lasting persistent atrial fibrillation. PLoS One 2011;6:e22122.
  21. Sauren LD, la Meir M, de Roy L, Pison L, van der Veen FH, Mess WH et al. Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach. Eur J Cardiothorac Surg 2009;36:833-7.
  22. Yilmaz A, Geuzebroek GS, Van Putte BP, Boersma LV, Sonker U, De Bakker JM et al. Completely thoracoscopic pulmonary vein isolation with gangli- onic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation. Eur J Cardiothorac Surg 2010;38:356-60.
  23. Castella M, Pereda D, Mestres CA, Gomez F, Quintana E, Mulet J. Thoracoscopic pulmonary vein isolation in patients with atrial fibrillation and failed percutaneous ablation. J Thorac Cardiovasc Surg 2010;140: 633-8.
  24. Katritsis DG, Giazitzoglou E, Zografos T, Pokushalov E, Po SS, Camm AJ. Rapid pulmonary vein isolation combined with autonomic ganglia modifi- cation: a randomized study. Heart Rhythm 2011;8:672-8.
  25. Zhou Q, Hou Y, Yang S. A meta-analysis of the comparative efficacy of ab- lation for atrial fibrillation with and without ablation of the ganglionated plexi. Pacing Clin Electrophysiol 2011;34:1687-94.
  26. Lemola K, Chartier D, Yeh YH, Dubuc M, Cartier R, Armour A et al. Pulmonary vein region ablation in experimental vagal atrial fibrillation: role of pulmonary veins versus autonomic ganglia. Circulation 2008;117:470-7.
  27. Scanavacca M, Pisani CF, Hachul D, Lara S, Hardy C, Darrieux F et al. Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation. Circulation 2006;114:876-85.
  28. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Mohanty S, Horton R et al. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation 2010;122:109-18.
  29. Tsai YC, Phan K, Munkholm-Larsen S, Tian DH, La Meir M, Yan TD. Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis. Eur J Cardiothorac Surg 2014;47: 847-54.
  30. Hwang C, Chen PS. Ligament of Marshall: why it is important for atrial fibrillation ablation. Heart Rhythm 2009;6:S35-40.
  31. Kim DT, Lai AC, Hwang C, Fan LT, Karagueuzian HS, Chen PS et al. The Ligament of Marshall: a structural analysis in human hearts with implica- tions for atrial arrhythmias. J Am Coll Cardiol 2000;36:1324-7.
  32. Yoshida K, Aonuma K. Catheter ablation of atrial fibrillation: past, present, and future directions. J Arrhythm 2012;28:83-90.
  33. Thomas SP, Aggarwal G, Boyd AC, Jin Y, Ross DL. A comparison of open irrigated and non-irrigated tip catheter ablation for pulmonary vein isola- tion. Europace 2004;6:330-5.
  34. Kearney K, Stephenson R, Phan K, Chan WY, Huang MY, Yan TD. A system- atic review of surgical ablation versus catheter ablation for atrial fibrilla- tion. Ann Cardiothorac Surg 2014;3:15-29.
  35. Bahnson TD. Strategies to minimize the risk of esophageal injury during catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol 2009;32: 248-60.
  36. Singh SM, d'Avila A, Doshi SK, Brugge WR, Bedford RA, Mela T et al. Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circ Arrhythm Electrophysiol 2008;1:162-8.

Authors
Phan, K., Phan, S., Thiagalingam, A., Medi, C., & Yan, T. D.
Affiliations
  • The University of Sydney (AU)
  • Collaborative Research Group (AU)
  • Royal Prince Alfred Hospital (AU)
Corresponding author
Yan, Tristan D.
ORCID
Venue
European Journal of Cardio-Thoracic Surgery
Publisher
Oxford University Press (OUP)
Published
2015-05-23
Volume
49
Issue
4
Pages
1044-1051
ISSN
  • 1010-7940 (ISSN-L)
  • 1873-734X
DOI
10.1093/ejcts/ezv180
OpenAlex
W2318568973
Cited by
76
References
39
Citations by year
2025: 6 · 2024: 5 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 9 · 2016: 11 · 2015: 3
FWCI
1.84
Type
journal article
Language
en
Open access
Locations
  • European Journal of Cardio-Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
atrial fibrillation, catheter ablation, refractory atrial fibrillation, antiarrhythmic drug failure, arrhythmia recurrence, repeat ablation, procedural complications, pleural effusion, pneumothorax, FAST trial
MeSH terms
Atrial Fibrillation, Female, Humans, Male, Middle Aged, Thoracoscopy, Catheter Ablation, Thoracic Surgery, Video-Assisted

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