Document Detail

How effective is microwave ablation for atrial fibrillation during concomitant cardiac surgery?
MedLine Citation:
PMID:  22510269     Owner:  NLM     Status:  MEDLINE    
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing microwave ablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). In total, 200 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Major exclusion criteria included studies exclusively using bipolar ablation, ambiguous or unspecified ablation technique, other energy modalities and studies with highly variable or undisclosed follow-up time. One study reported that 66% of patients were in sinus rhythm (SR) with follow-ups ranging from 1 to 14 months and suggested that the risk of AF recurrence was significantly increased with a larger left atrial diameter (OR = 1.21, P = 0.02) and an increased duration of preoperative AF (OR = 2.14, P = 0.03). A separate study found no significant difference in the success rate on the basis of the concomitant procedure (coronary artery bypass grafting or mitral valve surgery, P > 0.5). In the only randomized trial identified, microwave ablation delivered significantly inferior SR restoration rates to radiofrequency (RF) ablation at all time points from discharge to 24 months. There is a large degree of heterogeneity in the studies, with patients' characteristics, for example type of AF, and patient management postoperatively, for example administration of anti-arrhythmias, being inconsistent. Of the 12 studies, nine assessed SR at a mean of 6-12 months and found postoperative success rates between 62 and 87%. One study looked at the medium range follow-up of 24 months with SR restoration at 71%. Two studies looked at the long-term follow-up (5 and 5.37 years) with SR restoration at 39 and 61%, respectively. We conclude that microwave ablation, as an intervention for the treatment of AF during concomitant surgery, is not currently recommended on the limited available evidence. This is because the success rates in the longer term are less clear and the only randomized study to date has found inferior outcomes compared with RF-based ablation.
David Robert Walker MacDonald; Mahiben Maruthappu; Myura Nagendran
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-04-17
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  122-7     Citation Subset:  IM    
Green Templeton College, University of Oxford, Oxford, UK.
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MeSH Terms
Atrial Fibrillation / complications,  surgery*
Catheter Ablation / adverse effects,  methods*
Coronary Artery Bypass* / adverse effects
Coronary Artery Disease / complications,  surgery*
Evidence-Based Medicine
Heart Valve Diseases / complications,  surgery*
Heart Valve Prosthesis Implantation* / adverse effects
Microwaves / adverse effects,  therapeutic use*
Middle Aged
Mitral Valve / surgery*
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):128   [PMID:  22723543 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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