New Guidelines: Surgical Ablation of Atrial Fibrillation. Niv Ad, MD
|
|
- Timothy Blair
- 5 years ago
- Views:
Transcription
1 New Guidelines: Surgical Ablation of Atrial Fibrillation Niv Ad, MD
2 Potential conflicts of interest Niv Ad, MD I have the following potential conflicts of interest to report: Atricure Inc.: Medtronic: LivaNova: Nido Surgical: Speaker and Consulting Training and Consulting Training and Consulting Advisory Board LAA Closure LLC: Co-owner
3 AF Definitions Paroxysmal Persistent LS Persistent Permanent AF that terminates spontaneously or within 7 d Continuous AF sustained > 7d Continuous AF sustained > 12m Joint decision, no effort to maintain SR
4 Classification of Strength of Recommendation Class I (Strong; Benefit >>> Risk): Procedure is useful, effective, and beneficial. Recommendation: procedure should be performed. Class IIA (Moderate; Benefit >> Risk): Procedure can be useful, effective, and beneficial. Recommendation: procedure is reasonable. Class IIB (Weak; Benefit Risk): Effectiveness is unknown, unclear, or uncertain. Recommendation: procedure might be reasonable. Class III - No Benefit (Moderate; Benefit = Risk): Procedure is not useful, effective, or beneficial. Recommendation: procedure should not be performed. Class III - Harm (Strong; Benefit < Risk): Procedure potentially causes harm or excess mortality/morbidity. Recommendation: procedure should not be performed.
5 Level of Quality of Evidence (LOE) Level A: High quality evidence from more than 1 RCT; meta-analyses or high quality RCTs; or one or more RCTs corroborated by high quality registry studies. Level B-R: Moderate quality evidence from 1 or more RCTs or meta-analyses of moderate quality. Level B-NR: Moderate quality of evidence from 1 or more well-designed wellexecuted non-randomized studies, registries, or observational analyses; metaanalyses of such studies. Level C-LD: Randomized or non-randomized observational or registry studies with limitations of design or execution; meta-analyses of such studies; mechanistic or physiological investigation in human subjects. Level C-EO: Consensus of expert opinion based on clinical experience.
6
7 Methods Meta-analyses planned to investigate Research Questions 1 4 Studies identified through PubMed search using comprehensive search terms for each question Study period confined to Jan 2000 Dec 2015 Inclusion criteria: studies with concomitant surgical ablation procedures (full lesion set or limited), adult human population, comparison group present, English language studies For Questions 5 7, meta-analyses not possible and literature summaries conducted instead
8 Methods Meta-analyses conducted using Comprehensive Meta-Analysis Version Heterogeneity for each outcome tested using Cochran s Q value and I 2 statistic Analyses with significant heterogeneity conducted using random effects models whereas all other analyses conducted using fixed effects modeling Forest plots generated for each outcome and separately for RCT and non-rct studies when necessary
9 Methods Meta-analyses conducted to investigate 4 major Questions: 1. Does concomitant surgical ablation for atrial fibrillation increase the incidence of perioperative morbidity? 2. A: Does concomitant surgical ablation for atrial fibrillation reduce the incidence of early stroke/transient ischemic attack (TIA)? B: Does concomitant surgical ablation for atrial fibrillation reduce the incidence of late stroke/tia? 3. Does concomitant surgical ablation for atrial fibrillation improve health-related quality of life and AF-related symptoms? 4. A: Does concomitant surgical ablation for atrial fibrillation improve operative survival (<30 days) B: Does concomitant surgical ablation for atrial fibrillation improve long- term survival?
10 Methods 5. What are the indications for a hybrid ablation or stand alone off bypass ablation in patients with atrial fibrillation? 6. Which surgical ablation devices are associated with reliable transmural lesions? 7. Should surgeons performing Surgical Ablation be required to undergo basic training and education
11 1: Does concomitant surgical ablation for AF increase the incidence of perioperative morbidity? Outcome operationalized as complications within 30 days of surgery including: DSWI, pneumonia, Reop for bleeding, renal failure, renal failure requiring dialysis, readmission <30 days, LOS in ICU, hospital LOS 905 studies identified from original PubMed search, of which 300 reviewed in depth for inclusion, and 27 studies met inclusion criteria Remaining 273 studies excluded due to no comparison group (n=245), case report (n=7), no outcome data (n=17), or duplicate data from same investigators (n=4)
12 1: Does concomitant surgical ablation for AF increase the incidence of perioperative morbidity? Recommendation #1: Addition of a concomitant surgical ablation procedure for atrial fibrillation does not increase incidence of perioperative morbidity. Class IIa Level of Evidence: Level A for DSWI, pneumonia, reoperation for bleeding, and renal failure requiring dialysis Level B-R for ICU LOS and total hospital LOS Level B-NR for readmission <30 days and renal failure
13 Forest Plot Pneumonia Model Study name Subgroup within study Outcome Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 82. Yoo Non-RCT Pneumonia Ad Non-RCT Pneumonia Saint Non-RCT Pneumonia Budera RCT Pneumonia Abreu Filho RCT Pneumonia Liu RCT Pneumonia Boersma RCT Pneumonia VasconcelosRCT Pneumonia Fixed Favors Surgical Ablation Favours A Favors Control Favours B Meta Analysis
14 Forest Plot Reoperation for Bleeding Model Study name Subgroup within study Outcome Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 82. Yoo Non-RCT Reop for bleeding Ad Non-RCT Reop for bleeding Saint Non-RCT Reop for bleeding McCarthy Non-RCT Reop for bleeding Budera RCT Reop for bleeding Kim JB Non-RCT Reop for bleeding Attaran Non-RCT Reop for bleeding Raanani Non-RCT Reop for bleeding Jatene Non-RCT Reop for bleeding Akpinar RCT Reop for bleeding Srivastava RCT Reop for bleeding Albrecht RCT Reop for bleeding de Lima RCT Reop for bleeding Boersma RCT Reop for bleeding VasconcelosRCT Reop for bleeding Fixed Favors Surgical Favours Ablation A Favors Favours Control B Meta Analysis
15 Forest Plot Total Hospital LOS Model Study name Subgroup within study Outcome Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 5. Gillinov RCT LOS Ad Non-RCT LOS McCarthy Non-RCT LOS Malaisrie Non-RCT LOS Attaran Non-RCT LOS von Oppell RCT LOS Jessurun RCT LOS Raanani Non-RCT LOS Blomstrom-Lundqvist RCT LOS Chevalier RCT LOS Doukas RCT LOS Boersma RCT LOS Schuetz RCT LOS Vasconcelos RCT LOS Fixed Random Favors Surgical Favours Ablation A Favors Favours Control B Meta Analysis
16 Research Question 2 Early and Late Strokes/TIA Outcome separated into early (in-hospital or <30 days) stroke and late or follow-up stroke 614 studies identified through PubMed search and additional 20 studies identified through reference lists of other articles 87 studies reviewed in depth for inclusion, and 20 met inclusion criteria Remaining 67 studies excluded due to no comparison group (n=23), catheter ablation rather than surgical ablation (n=17), duplicate data (n=10), no ablation (n=7), reviews (n=6), and no outcome data (n=4)
17 2A: Does concomitant surgical ablation for atrial fibrillation reduce the incidence of early stroke/transient ischemic attack (TIA)? Recommendation #2: Addition of a concomitant surgical ablation procedure for atrial fibrillation does not increase the incidence of early stroke/tia. Class IIa Level of Evidence Level A
18 Forest Plot Early Stroke/TIA Meta Analysis Model Study name Time point Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 77. Ad, N Perioperative Nakajima, H Perioperative Raanani, E Perioperative Mantovan, R Perioperative Johansson, B Perioperative Jatene, MB Perioperative Doukas, G Perioperative Albrecht, A Perioperative Blomstrom-Lundqvist, C Perioperative Jessurun, ER Perioperative Budera, P Perioperative Vasconcelos, JT Perioperative Fixed Random Favors Favours Surgical Ablation A Favors Favours Control B Meta Analysis
19 2B: Does concomitant surgical ablation for atrial fibrillation reduce the incidence of late stroke/tia? Recommendation #3: In genral concomitant surgical ablation for AF does not change incidence of late stroke/tia (RCT only 12 months) Subgroup analysis of non-rct trials found significant reduction in late stroke/tia incidence. Class IIa Level of Evidence: Level A for no change in incidence of late stroke/tia (up to 1 year after surgery) Level B-NR for reduction in incidence of late stroke/tia (>1 year after surgery)
20 Forest Plot Late Stroke/TIA Meta Analysis Model Study name Time point Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 713. Nakajima, H Follow-up Raanani, E Follow-up Johansson, B Follow-up Doukas, G Follow-up Blomstrom-Lundqvist, C Follow-up Akpinar, B Follow-up Bando, K Follow-up Wang, J Follow-up Budera, P Follow-up Vasconcelos, JT Follow-up Chevalier, P Follow-up Fixed Random Favors Favours Surgical AAblation Favours Favors Control B Meta Analysis
21 3: Does concomitant surgical ablation for atrial fibrillation improve health-related quality of life and AF-related symptoms? Standard meta-analysis not feasible due to heterogeneity in methods, postsurgery time points, and measures among studies Systematic review of relevant studies undertaken instead, allowing for studies with no control group 222 studies identified through PubMed search and 9 studies selected for inclusion: 4 RCT studies, 2 non-rct studies, and 3 studies with no control group All studies examined HRQL and 4 studies investigated symptom status
22 3: Does concomitant surgical ablation for atrial fibrillation improve health-related quality of life and AF-related symptoms? Recommendation #4: Addition of concomitant surgical ablation for AF improves health-related quality of life. Addition of concomitant surgical ablation for AF improves AF-related symptoms and is greater than in pts without surgical ablation. Class IIa Level of Evidence: Level B-R for health-related quality of life Level C-LD for AF-related symptoms
23 Research Question 4 Early and Late Survival Outcome separated into short-term (<30 days) and long-term ( 12 months) mortality 905 studies identified from PubMed search, of which 300 were reviewed in depth for inclusion, and 38 studies met inclusion criteria Remaining 262 studies excluded due to no comparison group (n=245), case report (n=7), no outcome (n=6), or duplicate data from the same investigators (n=4)
24 A: Does concomitant surgical ablation for atrial fibrillation improve operative survival (<30 days) Recommendation #5: Addition of concomitant surgical ablation for atrial fibrillation improves operative mortality (<30 days). Class I Level of Evidence: Level A
25 Forest Plot Operative and Early Survival Model Study name Comparison Time point Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 82. Yoo Non-RCT Operative Ad Non-RCT Operative Saint Non-RCT Operative Kim HJ Non-RCT Operative McCarthy Non-RCT Operative Budera RCT Operative Malaisrie Non-RCT Operative Kim JB Non-RCT Operative Attaran Non-RCT Operative Louagie Non-RCT Operative Abreu Filho RCT Operative Knaut Non-RCT Operative Nakajima Non-RCT Operative Chen Non-RCT Operative Raanani Non-RCT Operative Jatene Non-RCT Operative Blomstrom-Lundqvist RCT Operative Doukas RCT Operative Akpinar RCT Operative Srivastava RCT Operative Albrecht RCT Operative de Lima RCT Operative Schuetz RCT Operative Vasconcelos RCT Operative Fixed Favors Favours Surgical Ablation A Favors Favours Control B Meta Analysis
26 B: Does concomitant surgical ablation for atrial fibrillation improve long- term survival Recommendation #6: The addition of a concomitant surgical ablation procedure for atrial fibrillation improves long-term survival Subgroup analysis of RCT trials found no significant improvement (12 months). Class IIa Level of Evidence: Level A for no change in long-term survival (up to 1 year after surgery) Level B-NR for improvement in long-term survival (>1 year after surgery)
27 Forest Plot Long-term Survival Model Study name Comparison Time point Statistics for each study Odds ratio and 95% CI Odds Lower Upper ratio limit limit Z-Value p-value 5. Gillinov RCT Follow-up Wang RCT Follow-up Yoo Non-RCT Follow-up Ad Non-RCT Follow-up Kim HJ Non-RCT Follow-up Budera RCT Follow-up Malaisrie Non-RCT Follow-up Araki Non-RCT Follow-up Kim JB Non-RCT Follow-up Attaran Non-RCT Follow-up von Oppell RCT Follow-up Louagie Non-RCT Follow-up Stulak Non-RCT Follow-up Abreu Filho RCT Follow-up Knaut Non-RCT Follow-up Bando Non-RCT Follow-up Deneke RCT Follow-up Raanani Non-RCT Follow-up Jatene Non-RCT Follow-up Blomstrom-Lundqvist RCT Follow-up Chevalier RCT Follow-up Knaut RCT Follow-up Akpinar RCT Follow-up Srivastava RCT Follow-up Van Breugel RCT Follow-up Albrecht RCT Follow-up Boersma RCT Follow-up Vasconcelos RCT Follow-up Random Favors Favours Surgical Ablation A Favors Favours Control B Meta Analysis
28 5: What are the indications for a hybrid ablation or stand alone off bypass ablation in patients with atrial fibrillation? Recommendation #7: Overall, hybrid procedures have shown promising results compared to percutaneous catheter ablation in a subgroup of symptomatic patients with AF in which medical treatment and/or percutaneous catheter ablation have failed. Class IIb Level of Evidence: Level B-NR
29 Research Question 5 Off Pump PVI Recommendation #8: Overall, minimally invasive approaches to isolate the pulmonary veins bilaterally have shown promising results compared to percutaneous catheter ablation in a subgroup of symptomatic patients with paroxysmal AF and a small left atrium in which medical treatment and/or percutaneous catheter ablation have failed. Class IIa Level of evidence: Level B-R
30 6: Which surgical ablation devices are associated with reliable transmural lesions? Recommendation #9: The best evidence exists for the use of bipolar radiofrequency clamps (off and on Pump) and cryoablation devices (on Pump), which have become an integral part of many procedures including pulmonary vein isolation and the Cox maze IV procedure. We do not recommend the use of unipolar radiofrequency ablation outside of clinical trials, as its efficacy is questionable.
31 6: Which surgical ablation devices are associated with reliable transmural lesions? Empty arrested or beating heart: recommended ablation devices are bipolar radiofrequency clamps or reusable/disposable cryoprobes Beating heart: bipolar radiofrequency clamps effective to isolate pulmonary veins and recommended with mandatory testing for exit and/or entrance block Beating heart: surface bipolar radiofrequency devices may be recommended when lesion integrity can be tested and multiple applications are recommended to achieve adequate lesion depth Beating heart: epicardial cryoablation is not recommended, but endocardial cryoablation is recommended due to the high degree of transmurality Clinical trials or hybrid procedures: only settings where unipolar radiofrequency devices may be recommended with acute lesion integrity testing Ablation of coronary arteries with any device should be avoided
32 7: Should surgeons performing Surgical Ablation be required to undergo basic training and education Recommendation #10: Surgical ablation procedures should require basic training, proctoring, and education to improve surgeon understanding of atrial fibrillation, the surgical options and improve outcomes. Class I Level of evidence: Level C
33 Summary Concomitant surgical ablation for AF is safe and is either associated with no increased morbidity or improved operative outcomes Concomitant surgical ablation for AF is associated with excellent long term safety and improved symptoms and might be associated with reduced strokes and survival Ablation devices should be chosen carefully and based on good animal and clinical data Training and education should be standardized
34 AATS recommendations for future studies and intiatives Well designed studies are recommended to address long term survival and embolic complications Well designed studies are recommended to develop better understanding on the cost effectiveness of surgical ablation Well designed studies are required to assess the role of stand alone surgical ablation procedures to include a Cox-Maze procedure, off pump procedures to include the hybrid approach Training and education is recommended and considerations should be made to include surgical ablation in the residency curriculum
35
36 Mitral Surgery and Surgical Ablation Multiple populations studied: 11 RCTs, 4 Metaanalyses, Several Institutional experiences Recommendation: Surgical ablation for AF can be performed without additional operative risk, in experienced hands, and is recommended at the time of concomitant to mitral operations to restore sinus rhythm. COR: I, LOE: A
37 AVR, CABG, or AVR+CABG Limited populations studied: 2 RCTs, 2 Metaanalyses, limited Institutional experiences Recommendation: Surgical ablation for AF can be performed without additional operative risk in experienced hands and is recommended at the time of concomitant isolated AVR, isolated CABG, and AVR+CABG operations to restore sinus rhythm. COR: I, LOE: B-NR
38 Stand Alone Surgical Ablation Multiple populations studied: 4 RCTs, 4 Metaanalyses, Several Institutional experiences Recommendation: Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III anti-arrhythmic drugs and/or catheter-based therapy is reasonable to be performed as a primary stand-alone procedure in experienced hands to restore sinus rhythm. COR: IIA, LOE: B-R
39 Stand Alone Surgical Ablation Recommendation: Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable to be performed as a stand-alone procedure using the Cox-Maze III/IV lesion set compared to pulmonary vein isolation alone. (COR IIA, LOE B-NR) Surgical ablation for symptomatic paroxysmal AF in the absence of structural heart disease is reasonable to be performed as a stand-alone procedure using pulmonary vein isolation alone or the Cox-Maze III/IV procedure. (COR IIA, LOE B-NR)
40 Stand Alone Surgical Ablation Recommendation: Surgical ablation for symptomatic AF in the setting of left atrial enlargement ( 4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. COR III - No Benefit, C-EO
41 Left Atrial Appendage Management Recommendation: It is reasonable to perform LA appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (COR: IIA, LOE: C-LD). At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the LA appendage for longitudinal thromboembolic morbidity prevention (COR: IIA, LOE: C-EO).
42 Heart Team Management Recommendation: In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and follow-up can be useful and beneficial to optimize patient outcomes. COR: I, LOE: C-EO
New Guidelines: Surgical Ablation of Atrial Fibrillation. Niv Ad, MD West Virginia University Washington Adventist Hospital
New Guidelines: Surgical Ablation of Atrial Fibrillation Niv Ad, MD West Virginia University Washington Adventist Hospital Disclosures Medtronic Inc. : Speaker LivaNova : Speaker and Proctor Atricure Inc.
More informationWhat s New in the Guidelines for Surgical Ablation for Atrial Fibrillation?
What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation? Vinay Badhwar, MD Gordon F. Murray Professor and Chairman Department of Cardiovascular & Thoracic Surgery West Virginia University
More informationAATS STARS Meeting Miami Beach November 17, 2017
The New Surgical The Heart Ablation Hospital Guidelines AATS STARS Meeting Miami Beach November 17, 2017 The Heart Hospital Baylor Plano Plano, Texas James R. Edgerton, MD, FACS, FACC, FHRS Surgical Director
More informationClinical Practice Guidelines and the Under Treatment of Concomitant AF Vinay Badhwar, MD
Clinical Practice Guidelines and the Under Treatment of Concomitant AF Vinay Badhwar, MD Gordon F. Murray Professor and Chairman Department of Cardiovascular & Thoracic Surgery WVU Heart and Vascular Institute
More informationShould Paroxysmal Atrial Fibrillation be Treated During Cardiac Surgery?
Should Paroxysmal Atrial Fibrillation be Treated During Cardiac Surgery? Patrick M. McCarthy MD, Adarsh Manjunath, BA, Jane Kruse, RN, BSN, Adin-Cristian Andrei, PhD, Zhi Li, MS, Edwin C. McGee, MD, S.
More informationSurgical AF Ablation : Lesion Sets and Energy Sources. What are the data? Steven F Bolling, MD Cardiac Surgery University of Michigan
Surgical AF Ablation : Lesion Sets and Energy Sources What are the data? Steven F Bolling, MD Cardiac Surgery University of Michigan Disclosures Consultant/Advisory Board: Abbott, Edwards Lifesciences
More informationMinimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation
Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation Niv Ad, MD Chief, Cardiac Surgery Inova Heart and Vascular Institute Disclosures Niv Ad: Medtronic
More informationSURGICAL ABLATION OF ATRIAL FIBRILLATION DURING MITRAL VALVE SURGERY THE CARDIOTHORACIC SURGICAL TRIALS NETWORK
SURGICAL ABLATION OF ATRIAL FIBRILLATION DURING MITRAL VALVE SURGERY THE CARDIOTHORACIC SURGICAL TRIALS NETWORK Marc Gillinov, M.D. For the CTSN Investigators ACC Late Breaking Clinical Trials March 16,
More informationBiatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD
Biatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD Disclosures Consultant/Speaker AtriCure Medtronic CryoLife Edwards Abbott Research Funding Abbott Equity Interest Clear Catheter Cleveland Clinic
More informationStand alone maze: when and how?
Stand alone maze: when and how? Dong Seop Jeong Department of Thoracic and Cardiovascular Surgery, HVSI Samsung Medical Center Type of atrial fibrillation First diagnose AF Paroxysmal AF: self-terminating
More informationSurgical Ablation: Which Lesion Set for Which Patient?
Surgical Ablation: Which Lesion Set for Which Patient? Patrick M. McCarthy MD, FACC Director of the Bluhm Cardiovascular Institute Chief of Cardiac Surgery Division Heller-Sacks Professor of Surgery in
More informationSurgical Ablation of Atrial Fibrillation. Gregory D. Rushing, MD. Assistant Professor, Division of Cardiac Surgery
Surgical Ablation of Atrial Fibrillation Gregory D. Rushing, MD Assistant Professor, Division of Cardiac Surgery Midwestern Conference on Optimizing Electrophysiology Patient Care and Procedural Success
More informationAtrial Fibrillation Procedures Data Summary. Participant STS Period Ending 12/31/2016
Period Ending 12/31/2016 Number of Cases Preoperative Predominant Atrial Arrhythmia Type Paroxysmal Atrial Fibrillation... - - Persistent Atrial Fibrillation... - - Longstanding Persistent Atrial Fibrillation...
More informationSurgical Ablation for Lone AF: What have we learned after 30 years?
Surgical Ablation for Lone AF: What have we learned after 30 years? Ralph J. Damiano, Jr., MD Evarts A. Graham Professor of Surgery Chief of Cardiothoracic Surgery Vice Chairman, Department of Surgery
More informationCombined catheter ablation and left atrial appendage closure as a. treatment of atrial fibrillation
Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation Giulio Molon, MD FACC, FESC, Fellow ANMCO Card Dept, S.Cuore hospital Negrar
More informationManuel Castella MD PhD Hospital Clínic, University of
Manuel Castella MD PhD Hospital Clínic, University of Barcelona mcaste@clinic.ub.es @mcastellamd www.escardio.org/guidelines European Heart Journal - doi:10.1093/eurheartj/ehw210 Providing integrated care
More informationHybrid Surgical Ablation in South America: Lesson Learned. Joao R. Breda
Hybrid Surgical Ablation in South America: Lesson Learned Joao R. Breda DISCLOSURES NONE 2 How to treat Atrial Fibrillation (AF) Understanding of pathophysiology mechanisms Ablation approach Choice of
More informationDefinition of Success and Surgical Results That Shouldn t Be a Hard Talk, Right?
Definition of Success and Surgical Results That Shouldn t Be a Hard Talk, Right? Patrick M. McCarthy MD, FACC Executive Director of the Bluhm Cardiovascular Institute Chief of Cardiac Surgery Division
More informationPage: 1 of 22. Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
7.01.14 Last Review Status/Date: September 2015 Page: 1 of 22 to Treat Atrial Fibrillation and Atrial Description There are a variety of surgical approaches to treat atrial fibrillation (AF) that work
More informationConcurrent AF Ablation with Mitral Valve Surgery
Concurrent AF Ablation with Mitral Valve Surgery James L. Cox, MD Surgical Director, Center for Heart Rhythm Disorders Bluhm Cardiovascular Institute Professor of Surgery Feinberg School of Medicine Northwestern
More informationAF ABLATION Concepts and Techniques
AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications
More informationThe EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On?
The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? L. Pison, MD PhD FESC AATS Surgical Treatment of Arrhythmias and Rhythm Disorders November 17-18, 2017 Miami Beach, FL, USA
More informationThe Journal of Thoracic and Cardiovascular Surgery
Accepted Manuscript Judgement Day: Should You Add Atrial Fibrillation Ablation? Dr. Patrick M. McCarthy, MD PII: S0022-5223(18)32917-9 DOI: https://doi.org/10.1016/j.jtcvs.2018.11.004 Reference: YMTC 13719
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationAtrial Fibrillation Ablation: in Whom and How
Update on Consensus Statement on Management of Atrial Fibrillation: EHRA 2012 Atrial Fibrillation Ablation: in Whom and How Update of HRS/EHRA AF/ECAS Ablation Document 2012 Anne M Gillis MD FHRS Professor
More informationWhat is Minimally Invasive Surgical Ablation?
What is Minimally Invasive Surgical Ablation? ( and who might be suitable for it?) HRC October 2011 Mr. Jonathan Hyde Consultant Cardiac Surgeon Royal Sussex County Hospital, Brighton Introduction Atrial
More informationSurgical ablation for chronic atrial fibrillation. M.M.El-Fiky
Surgical ablation for chronic atrial fibrillation M.M.El-Fiky Types of atrial fibrillation 1 st detection 23% Paroxysmal 38% Persistent Slow progression After 1y = 8.6% After 5 y = 24.7%* 39% Permanent
More informationFDA Executive Summary. Prepared for the October 26, 2011 meeting of the Circulatory System Devices Panel
FDA Executive Summary Prepared for the October 26, 2011 meeting of the Circulatory System Devices Panel P100046 AtriCure Synergy Ablation System AtriCure, Inc. Introduction This is the FDA Executive Summary
More informationTrial design and selection criteria
Background Cox-MAZE open chest, cardiac surgery was a very successful invasive procedure for treatment of AF 1, but highly invasive Since the landmark trial by Haissaguerre et al. 2, PV isolation by catheter
More informationOpen and Thoracoscopic Approaches to Treat Atrial Fibrillation (Maze and Related Procedures)
7.01.14 Open and Thoracoscopic Approaches to Treat Atrial Fibrillation (Maze and Related Procedures) Section 7.0 Surgery Subsection Effective Date November 26, 2014 Original Policy Date December 7, 2006
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
266 NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of microwave ablation for atrial fibrillation as an associated procedure with other
More information부정맥 3 Debaste 2. 08:30~10:00: 4 회의장
부정맥 3 Debaste 2. 08:30~10:00: 4 회의장 130420 Sinus Node Dysfunction vs. Atrial Fibrillation 45 years old man, persistent AF, planned for MVR, LA 69mm, EF 70%: Does he need additional maze surgery? CON Hui-Nam
More informationDebate-STAR AF 2 study. PVI is not enough
Debate-STAR AF 2 study PVI is not enough Debate about STAR AF 2 trial STAR AF trial Substrate and Trigger Ablation for Reduction of Atrial Fibrillation EHJ 2010 STAR-AF 2 trial One Size Fits All? PVI is
More informationBipolar Radiofrequency Energy
Bipolar Radiofrequency Energy Ralph J. Damiano, Jr., MD Evarts A. Graham Professor of Surgery Chief, Division of Cardiothoracic Surgery Barnes-Jewish Hospital Washington University School of Medicine St.
More informationOpen and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its
More informationAF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT
AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT 5-2014 Atrial Fibrillation therapeutic Approach Rhythm Control Thromboembolism Prevention: Recommendations Direct-Current
More information2018 CODING AND REIMBURSEMENT FOR. Cardiac Surgical Ablation and Left Atrial Appendage Management
2018 CODING AND REIMBURSEMENT FOR Cardiac Surgical Ablation and Left Atrial Appendage Management Introduction This information is shared for educational purposes and current as of January 2018. Healthcare
More informationManuel Castellá Cardiovascular Surgery Hospital Clínic, Universidad de
When not to exclude the LAA Manuel Castellá Cardiovascular Surgery Hospital Clínic, Universidad de Barcelona mcaste@clinic.ub.es @mcastellamd Normal hearts Patient in sinus rhythm Patient in AF (with
More informationThe HISTORIC-AF TRIAL
European Prospective Multicenter Study of Hybrid Thoracoscopic and Transcatheter Ablation of Persistent Atrial Fibrillation: The HISTORIC-AF TRIAL Claudio Muneretto 1, Gianluigi Bisleri 1, Gianluca Polvani
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
271 NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of cryoablation for atrial fibrillation as an associated procedure with other cardiac
More information2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation
Summary of Expert Consensus Statement for CLINICIANS 2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation This is a summary of the Heart
More informationATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION
ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships
More informationMEDICAL POLICY SUBJECT: MAZE PROCEDURES FOR ATRIAL FIBRILLATION. POLICY NUMBER: CATEGORY: Technology Assessment
MEDICAL POLICY PAGE: 1 OF: 8 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationCORONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW
CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP OVERVIEW 2015 PQRS OPTIONS F MEASURES GROUPS: 2015 PQRS MEASURES IN CONARY ARTERY BYPASS GRAFT (CABG) MEASURES GROUP: #43 Coronary Artery Bypass Graft (CABG):
More informationCatheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD
Catheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD Taipei Veterans General Hospital, Taiwan Outline of AF Ablation 1. Strategy for Catheter Ablation of AF 2. Substrate
More informationSurgical Ablation for Atrial Fibrillation in Cardiac Surgery
CONSENSUS STATEMENT Surgical Ablation for Atrial Fibrillation in Cardiac Surgery A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2009 Niv Ad, MD,*
More informationShould hybrid ablation be the standard of care instead of transcatheter ablation techniques?
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar
More informationAtrial Fibrillation Correction Surgery: Lessons From The Society of Thoracic Surgeons National Cardiac Database
Atrial Fibrillation Correction Surgery: Lessons From The Society of Thoracic Surgeons National Cardiac Database James S. Gammie, MD, Michel Haddad, MD, Sarah Milford-Beland, MS, Karl F. Welke, MD, T. Bruce
More informationPredictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation
Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation Simon Pecha, MD, a Timm Sch afer, MD, a Yalin Yildirim, MD, a Teymour Ahmadzade, MD, a Stephan
More informationSurgical thermoablation of atrial fibrillation: Epicardial
Surgical thermoablation of atrial fibrillation: Epicardial Nicolas Bonnet Centre Cardiologique du Nord CCN Saint Denis FRANCE Place of Surgery in AF treatment Historical Models and concepts Treatments
More informationIs cardioversion old hat? What is new in interventional treatment of AF symptoms?
Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Joseph de Bono Consultant Electrophysiologist University Hospitals Birmingham Atrial Fibrillation (AF) Affects 2% of the
More informationMitral Repair/AF Ablation Sternotomy Approach
Mitral Repair/AF Ablation Sternotomy Approach Patrick M. McCarthy MD, FACC Executive Director of the Bluhm Cardiovascular Institute Chief of Cardiac Surgery Division Heller-Sacks Professor of Surgery in
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A AADs. See Antiarrhythmic drugs (AADs) ACE inhibitors. See Angiotensin-converting enzyme (ACE) inhibitors ACP in transseptal approach to
More informationThe problem with concomitant atrial fibrillation in non-mitral valve surgery
Safeguards and Pitfalls The problem with concomitant atrial fibrillation in non-mitral valve surgery Mark La Meir 1,2, Sandro Gelsomino 2, Bart Nonneman 3 1 Department of Cardiothoracic Surgery, University
More informationA systematic review of surgical ablation versus catheter ablation for atrial fibrillation
Systematic Review A systematic review of surgical ablation versus catheter ablation for atrial fibrillation Katherine Kearney, Rowan Stephenson 2, Kevin Phan, Wei Yen Chan 3, Min Yin Huang 3, Tristan D.
More informationInterventional solutions for atrial fibrillation in patients with heart failure
Interventional solutions for atrial fibrillation in patients with heart failure Advances in Cardiovascular Arrhythmias Great Innovations in Cardiology Matteo Anselmino, MD PhD Division of Cardiology Department
More informationIncidence and Predictors of Pacemaker Placement After Surgical Ablation for Atrial Fibrillation
Incidence and Predictors of Pacemaker Placement After Surgical Ablation for Atrial Fibrillation Berhane Worku, MD, Sang-Woo Pak, MD, Faisal Cheema, MD, Mark Russo, MD, Brian Housman, BA, Danielle Van Patten,
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute ischemic stroke TOAST classification of, 270 Acute myocardial infarction (AMI) cardioembolic stroke following, 207 208 noncardioembolic
More informationConcomitant procedures using minimally access
Surgical Technique on Cardiac Surgery Concomitant procedures using minimally access Nelson Santos Paulo Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Oporto, Portugal Correspondence to:
More informationDipen Shah Cardiology Service, University Hospitals, Geneva Switzerland
Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland Disclosures Research Grants: Biosense Webster, St. Jude, Bard, Endosense, Biotronik Speakers Honoraria: Biosense Webster, Endosense,
More informationA MULTIDISCIPLINARY APPROACH TO ATRIAL FIBRILLATION: OUR EXPERIENCE WITH THE CONVERGENT PROCEDURE
A MULTIDISCIPLINARY APPROACH TO ATRIAL FIBRILLATION: OUR EXPERIENCE WITH THE CONVERGENT PROCEDURE Joe Aoun, MD Ioannis Koulouridis, MD, MSc Aleem Mughal, MD Maxwell Eyram Afari, MD Caroline Zahm, MD John
More informationContemporary Strategies for Catheter Ablation of Atrial Fibrillation
Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Suneet Mittal, MD Director, Electrophysiology Medical Director, Snyder Center for Atrial Fibrillation The Arrhythmia Institute at The
More informationInvasive and Medical Treatments for Atrial Fibrillation. Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic
Invasive and Medical Treatments for Thomas J Dresing, MD Section of Electrophysiology and Pacing Cleveland Clinic Disclosures Fellow s advisory panel for St Jude Medical Speaking honoraria from: Boston
More informationHybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure. Spectrum of Atrial Fibrillation
Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure Paul J. Wang, MD Amin Al-Ahmad, MD Gan Dunnington, MD Stanford University Cox J, et al. Ann Thorac Surg. 1993;55:578-580.
More informationCatheter ablation of AF Where do we stand, where do we go?
Catheter ablation of AF Where do we stand, where do we go? Sébastien Knecht MD, PhD Hôpital cardiologique du Haut L Evêque, Bordeaux Declaration of conflict of interest ABLATION STRATEGIES Duration proc:
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationCardiology Research Newsletter
in partnership with Cardiology Research Newsletter Fall 2016 Issue Six Percutaneous Approach to Correct Functional Mitral Regurgitation The AccuCinch clinical trial is an early feasibility study designed
More informationThe Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It. Chandra Kumbar MD FACC FHRS The Heart Group, Evansville IN
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It Chandra Kumbar MD FACC FHRS The Heart Group, Evansville IN Disclosures Consultant Advisory Board, Medtronic Atrial fibrillation
More informationControversies in Atrial Fibrillation and HF
Controversies in Atrial Fibrillation and HF Dr.Yahya Al Hebaishi Cardiac electrophysiology division, PSCC, Riyadh Atrial Fibrillation: Rate or Rhythm? HF and AF: the twin epidemic of cardiovascular disease.
More informationRecurrent Stroke under Anticoagulation in Mild MS & AF
Recurrent Stroke under Anticoagulation in Mild MS & AF - Minimal maze operation and LAA excision or exclusion- Seung Hyun Lee, M.D, Ph.D Division of Thoracic and Cardiovascular surgery Severance cardiovascular
More informationPage 1. Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion. Atrial fibrillation: Scope of the problem
Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion Benjamin A. D Souza, MD, FACC, FHRS Assistant Professor of Clinical Medicine Penn Presbyterian Medical Center Cardiac
More informationDevices to Protect Against Stroke in Atrial Fibrillation
Devices to Protect Against Stroke in Atrial Fibrillation Jonathan C. Hsu, MD, MAS Associate Clinical Professor Division of Cardiology, Section of Cardiac Electrophysiology June 2, 2018 Disclosures Honoraria
More informationAtrial Fibrillation Ablation Thinktank
Atrial Fibrillation Ablation Thinktank Mitchell J. Magee, M.D. STS National Database Taskforce CRSTI Dallas, TX FDA, Silver Spring, MD April 27, 2009 STS National Database Current Status Update Adult Cardiac
More informationMEDICAL POLICY I. POLICY
Original Issue Date (Created): April 26, 2011 Most Recent Review Date (Revised): September 24, 2013 Effective Date: November 1, 2013 I. POLICY The maze procedure, performed on a non-beating heart during
More informationMid-Term Results of Intraoperative Radiofrequency Ablation
Kitakanto Med J 37 2003 ; 53 : 37 `41 Mid-Term Results of Intraoperative Radiofrequency Ablation A new approach to atrial fibrillation Susumu Ishikawa,1 Jai S. Raman,1 Brian F. Buxton1 and Yasuo Morishita
More informationDual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS F INDIVIDUAL MEASURES: REGISTRY
More informationProgression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro
Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro Jerónimo Farré MD, Madrid, ES AF: the kingdom of wishful thinking In AF we
More informationA PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE. Reducing the risk of stroke in atrial fibrillation
A PATIENT S GUIDE TO THE LEFT ATRIAL APPENDAGE CLOSURE Reducing the risk of stroke in atrial fibrillation TABLE OF CONTENTS IMPORTANT Please Note: Information provided by Boston Scientific Corporation
More informationCatheter Ablation: Atrial fibrillation (AF) is the most common. Another Option for AF FAQ. Who performs ablation for treatment of AF?
: Another Option for AF Atrial fibrillation (AF) is a highly common cardiac arrhythmia and a major risk factor for stroke. In this article, Dr. Khan and Dr. Skanes detail how catheter ablation significantly
More informationESSA HEART AND VASCULAR INSTITUTE APR/MAY/JUNE 2009 CLINICAL LETTER
CLINICAL LETTER Exciting things are happening at the ESSA Heart and Vascular Institute and the Pocono Medical Center! We are all proud of the stellar team of professionals who are working very hard to
More informationSupplementary Online Content
1 Supplementary Online Content Friedman DJ, Piccini JP, Wang T, et al. Association between left atrial appendage occlusion and readmission for thromboembolism among patients with atrial fibrillation undergoing
More informationThe multi purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies
Ad Evolving Technology The multi purse string maze procedure: A new surgical technique to perform the full maze procedure without atriotomies Niv Ad, MD Objective: The maze procedure is the most effective
More informationCatheter Ablation of Atrial Fibrillation Persistent Atrial Fibrillation Catheter Ablation : where are we?
Catheter Ablation of Atrial Fibrillation Persistent Atrial Fibrillation Catheter Ablation : where are we? F. HIDDEN-LUCET francoise.hidden-lucet@aphp.fr Pitié-Salpétrière APHP FRANCE Disclosure Statement
More informationListen to Your Heart. What Everyone Needs To Know About Atrial Fibrillation & Stroke. The S-ICD System. The protection you need
Listen to Your Heart The S-ICD System What Everyone Needs To Know About Atrial Fibrillation & Stroke The protection you need without Stroke. touching Are you your at heart risk? Increase your knowledge.
More informationModern aspects in multidisciplinary thromboembolic prophylaxis. AMPLATZER Left Atrial Appendage data update
Modern aspects in multidisciplinary thromboembolic prophylaxis AMPLATZER Left Atrial Appendage data update Igal Moarof, MD Interventional Cardiology Kantonsspital Aarau Potential conflicts of interest
More informationSurgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea
Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea Contents Decision making in surgical AVR in old age Clinical results of AVR with tissue valve Impact of 19mm
More informationIsolator Synergy Ablation System THE ONLY FDA-APPROVED SURGICAL DEVICE TO TREAT ATRIAL FIBRILLATION
Isolator Synergy Ablation System THE ONLY FDA-APPROVED SURGICAL DEVICE TO TREAT ATRIAL FIBRILLATION WWW.ATRICURE.COM Why the Isolator Synergy Ablation System by AtriCure? / UNIQUE LESION FORMATION A lesion
More informationOn behalf of the RE-CIRCUIT Investigators. March 19, :45 am 10:55 am. Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Safety and Efficacy of Uninterrupted Anticoagulation with Dabigatran Etexilate versus in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The RE-CIRCUIT Study Hugh Calkins, M.D., 1 Stephan
More informationPurse-String Pv Box Isolation: A Less Invasive Modified Maze Procedure For Non-Mitral Atrial Fibrillation
Purse-String Pv Box Isolation: A Less Invasive Modified Maze Procedure For Non-Mitral Atrial Fibrillation T. Taguchi, K. Imai, M. Watanabe, H. Kodama, K. Katayama, S. Takahashi, T. Kurosaki, T. Sueda Department
More informationCatheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method. Konstantinos P.
Ioannina 2015 Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method Konstantinos P. Letsas, MD, FESC SECOND DEPARTMENT OF CARDIOLOGY LABORATORY
More information2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease Developed in Collaboration with American Association for Thoracic Surgery, American
More informationHow Should we Select Patients for Catheter Ablation? Douglas Esberg, MD, FHRS
How Should we Select Patients for Catheter Ablation? Douglas Esberg, MD, FHRS November 2, 2018 2 3 4 5 Atrial Flutter Typical isthmus dependent flutter Success rate ~95% Complications 1% (mostly groin
More informationAtrial fibrillation and advanced age
Atrial fibrillation and advanced age Prof. Fiorenzo Gaita Director of the Cardiology School University of Turin, Italy Prevalence of AF in the general population Prevalence and age distribution in patients
More informationThe CHADS Score Role in Managing Anticoagulation After Surgical Ablation for Atrial Fibrillation
The CHADS Score Role in Managing Anticoagulation After Surgical Ablation for Atrial Fibrillation Niv Ad, MD, Linda Henry, PhD, RN, Karen Schlauch, PhD, Sari D. Holmes, PhD, and Sharon Hunt, MBA Inova Heart
More informationThe Maze III procedure was introduced in 1995 as a
Long-Term Effects of the Maze Procedure on Atrial Size and Mechanical Function Stefan Lönnerholm, MD, Per Blomström, MD, Leif Nilsson, MD, and Carina Blomström-Lundqvist, MD Departments of Cardiology and
More informationLa terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO
La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO Rhythm or rate control strategy? N Engl J Med 2002;347:1834 40 Rate Control versus Electrical Cardioversion for Persistent
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationLong Standing Persistent AF ; CPVI is enough for it
Long Standing Persistent AF ; CPVI is enough for it Kee-Joon Choi, MD University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea Boston AF Symposium 2012 In a patient undergoing AF ablation
More informationExpanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated?
Expanding Relevance of Aortic Valve Repair Is Earlier Operation Indicated? RM Suri, V Sharma, JA Dearani, HM Burkhart, RC Daly, LD Joyce, HV Schaff Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More information