Image: New guidelines recommend surgical ablation for treating atrial fibrillation (Photo courtesy of Shutterstock).
New clinical practice guidelines issued by the Society of Thoracic Surgeons (STS; Chicago, IL, USA) conclude that surgical ablation as a treatment option for atrial fibrillation (AF) has experienced continued development over the last 30 years, with its frequency and success steadily increasing, and as such deserves a more prominent role in adult cardiac surgery.
In developing the new guidelines, the STS writing committee assessed the safety of surgical ablation for three surgical approaches: primary open atrial operations, where the left atrium is already being opened, such as in mitral valve and/or tricuspid valve repair or replacement; primary closed atrial operations, when the left atrium would not otherwise be open, such as coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) operations; and standalone operations when the only goal is to perform surgical ablation to treat AF.
The new clinical practice guidelines offer evidence-based recommendations that include surgical ablation for AF at the time of concomitant mitral operations to restore cardiac rhythm; surgical ablation for AF at the time of concomitant isolated AVR, isolated CABG, and AVR+CABG operations to restore cardiac rhythm; and surgical ablation as a primary standalone procedure to restore cardiac rhythm for symptomatic AF that is resistant to medication or catheter ablation. The new guidelines were published in the January 2017 issue of The Annals of Thoracic Surgery.
“These guidelines represent nearly two years of effort by some of the nation's leading experts in the surgical treatment of atrial fibrillation,” said co-author Professor Vinay Badhwar, MD, of the West Virginia University Heart & Vascular Institute (Morgantown, USA). “It is recognized that surgical ablation impacts long-term outcomes with improvements in normal heart rhythm, quality of life, and stroke reduction. Current evidence reveals that surgical ablation can be performed without significant impact to major complications or death.”
In patients with AF, rapid, disorganized electrical signals cause the atria to quiver, disturbing the normal rhythm between the atria and the ventricles. As a result, the ventricles may beat faster and without a regular rhythm, leading to blood clots, strokes, heart failure, and other complications. Surgical ablation, also known as the maze procedure, involves creating specific and defined lesions in the heart. The resulting scar tissue blocks the abnormal electrical signals, while also creating a controlled path for electricity in the heart to follow.
Society of Thoracic Surgeons
West Virginia University Heart & Vascular Institute