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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Atrial Fribillation, is surgical treatment an efficient option?
Session:
Painel 5 -Arritmologia 2
Speaker:
Rui Pedro Cerejo
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
Rui Pedro Cerejo; Carolina Rodrigues; Manuela Gouveia Silva; Nuno Banazol; Guilherme Portugal; Ana Lousinha; Bruno Tereno Valente; Pedro Silva Cunha; Mário Martins Oliveira; Rui Rodrigues; José Fragata
Abstract
<p><strong>Introduct</strong><strong>ion</strong></p> <p>Atrial Fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is increasing worldwide. It remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. Surgical ablation is currently considered one of the most effective treatments, with some of the best long term results even in the most “difficult” types of AF. Recent international guidelines advocate it for patients with symptomatic AF be as stand-alone or concomitant surgery. Despite this, it is still underperformed in our country. </p> <p><strong>Objectives</strong></p> <p>Evaluate the early results of an AF ablation surgery program.</p> <p><strong>Methods</strong></p> <p>Unicentric retrospective study, where all patients submitted to some form of surgical AF ablation (concomitant or stand-alone) from March 2016 till October 2019 were included. </p> <p>The indication for stand-alone surgery was symptomatic AF relapse after catheter ablation, and for concomitant surgery, symptomatic AF associated with structural heart disease. Cryoablation was used in open-right or left atrium surgery and radiofrequency in the other cases. The main primary outcome was establishment and duration of sinus rhythm in the course of follow-up. Mortality and morbidity (stroke, pace-maker implantation) were also evaluated.</p> <p><strong>Results</strong></p> <p>Fifty one patients with mean age of 62 years (37-79years) were submitted to surgical AF ablation. AF type was paroxysmal in 23 (45,1%), persistent in 8 (15,7%) and long-standing persistent in 20 (39,2%). Stand-alone AF ablation surgery was performed in 14 patients (27,5%) and in 37 patients (72,5%) was associated with concomitant procedures: mitral surgery (n=15), tricuspid surgery (n=4), aortic valve surgery (n=7), Morrow (n=1), CABG (n=4) and double valve surgery (n=6). Regarding complications: three (5,9%) definitive pacemaker implantations were needed and one (2,0%) early death was observed. Sinus rhythm at hospital discharge was present in 42 patients (82,4%). Mean follow-up time was 13 months. Thirty-four patients (68%) had at least one long term monitoring exam during follow-up (holter 24h, 7 days monitoring, pacemaker interrogation), and, till the last overall evaluation, 36 patients (72%) had no evidence of AF. There were no strokes or late mortality.</p> <p><strong>Conclusions</strong></p> <p>Surgical AF ablation is a safe procedure with better results compared with those reported for catheter ablation. We demonstrate that even in an initial phase of a surgical program, results are satisfactory and encouraging, and during follow-up we had very few complications. Finally, surgical AF ablation is still an underused procedure which has to grow to keep up with demand of AF treatment.</p>
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