The Society of Thoracic Surgeons (STS) has issued new clinical guidelines that include major recommendations for the use of surgical ablation when treating atrial fibrillation. The guidelines, posted online in The Annals of Thoracic Surgery, will appear in the January 2017 print issue.
“These guidelines represent nearly two years of effort by some of the nation’s leading experts in the surgical treatment of atrial fibrillation,” says guidelines co-author Vinay Badhwar, Gordon F Murray professor and chair of the West Virginia University Heart & Vascular Institute (Morgantown, USA). “This important document highlights the increasing global evidence on the safety and efficacy of surgical ablation for the treatment of atrial fibrillation.”
According to a press release, the literature revealed that surgical ablation as a treatment option for atrial fibrillation has experienced continued development over the last 30 years, with its frequency and success steadily increasing. The guideline writing committee merged these findings into a singular consensus paper to shape practice, concluding that surgical ablation is effective in reducing atrial fibrillation and improving quality of life, and so deserves a more prominent role in adult cardiac surgery.
“It is recognised that surgical ablation impacts long-term outcomes with improvements in normal heart rhythm, quality of life, and stroke reduction,” says Badhwar. “Current evidence reveals that surgical ablation can be performed without significant impact to major complications or death.”
In developing these new guidelines, the authors assessed the safety of performing surgical ablation for three surgical approaches: primary open atrial operations where the left atrium, or top chamber of the heart, is already being opened, such as mitral valve repair or replacement and/or tricuspid valve repair; 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 atrial fibrillation.
The new clinical practice guidelines offer evidence-based recommendations that include:
• Surgical ablation for atrial fibrillation at the time of concomitant mitral operations to restore cardiac rhythm;
• Surgical ablation for atrial fibrillation 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 atrial fibrillation that is resistant to medication or catheter ablation.
The authors also recommend a multidisciplinary heart team assessment, treatment planning, and long-term follow-up in order to optimize patient outcomes in the treatment of atrial fibrillation.
“These guidelines may help guide surgeons when faced with a challenging decision on the management of atrial fibrillation,” says Badhwar. “The guidelines represent an assimilation of the world’s literature; they do not supersede the final medical decision of the surgeon. It is important to remember that the ultimate choice of any therapy remains between the patient and their doctor.”
