Epicardial and endocardial surgical ablation of atrial fibrillation: outcomes from CASE-AF Registry.

0 CARDIAC & CARDIOVASCULAR SYSTEMS Interdisciplinary cardiovascular and thoracic surgery Pub Date : 2024-07-03 DOI:10.1093/icvts/ivae123
Ivana Mitrovic, Edgar Eszlari, Adi Cvorak, Andreas Liebold, Ardawan Rastan, Herko Grubitzsch, Michael Knaut, Theodor Fischlein, Taoufik Ouarrak, Jochen Senges, Thorsten Hanke, Nicolas Doll, Walter Eichinger
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Abstract

Objectives: The German CArdioSurgEry Atrial Fibrillation Registry is a prospective, multicentric registry analysing outcomes of patients undergoing surgical ablation for atrial fibrillation as concomitant or stand-alone procedures. This data sub-analysis of the German CArdioSurgEry Atrial Fibrillation Registry aims to describe the in-hospital and 1-year outcomes after concomitant surgical ablation, based on 2 different ablation approaches, epicardial and endocardial surgical ablation.

Methods: Between January 2017 and April 2020, 17 German cardiosurgical units enrolled 763 consecutive patients after concomitant surgical ablation. In the epicardial group, 413 patients (54.1%), 95.6% underwent radiofrequency ablation. In the endocardial group, 350 patients (45.9%), 97.7% underwent cryoablation. 61.5% of patients in the epicardial group and 49.4% of patients in the endocardial group presenting with paroxysmal atrial fibrillation. Pre-, intra- and post-operative data were gathered.

Results: Upon discharge, 32.3% (n = 109) of patients after epicardial surgical ablation and 24.0% (n = 72) of patients after endocardial surgical ablation showed recurrence of atrial fibrillation. The in-hospital mortality rate was low, 2.2% (n = 9) in the epicardial and 2.9% (n = 10) in the endocardial group. The overall 1-year procedural success rate was 58.4% in the epicardial and 62.2% in the endocardial group, with significant symptom improvement in both groups. The 1-year mortality rate was 7.7% (n = 30) in epicardial and 5.0% (n = 17) in the endocardial group.

Conclusions: Concomitant surgical ablation is safe and effective with significant improvement in patient symptoms and freedom from atrial fibrillation. Adequate cardiac rhythm monitoring should be prioritized for higher quality data acquisition.

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心外膜和心内膜心房颤动手术消融:CASE-AF 登记的结果。
目的:德国 CArdioSurgEry 心房颤动登记处是一个前瞻性、多中心登记处,旨在分析因心房颤动同时或单独接受手术消融治疗的患者的疗效。德国CArdioSurgEry心房颤动登记处的这项数据子分析旨在根据心外膜和心内膜手术消融这两种不同的消融方法,描述同期手术消融后的院内和一年预后:2017 年 1 月至 2020 年 4 月期间,德国 17 家心脏外科单位连续收治了 763 名同时接受手术消融的患者。心外膜组有 413 名患者(54.1%),其中 95.6% 接受了射频消融术。心内膜组有 350 名患者(45.9%),其中 97.7% 接受了低温消融术。心外膜组和心内膜组分别有 61.5% 和 49.4% 的患者出现阵发性心房颤动。收集了术前、术中和术后数据:出院时,32.3%(109 人)的心外膜手术消融患者和 24.0%(72 人)的心内膜手术消融患者出现房颤复发。院内死亡率较低,心外膜组为 2.2%(n = 9),心内膜组为 2.9%(n = 10)。心外膜组和心内膜组一年的总体手术成功率分别为58.4%和62.2%,两组患者的症状均有明显改善。心外膜组一年死亡率为7.7%(30人),心内膜组为5.0%(17人):结论:同期手术消融安全有效,可显著改善患者症状,使其摆脱心房颤动。为获得更高质量的数据,应优先进行充分的心律监测。
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