Kumar, NS;
Khanji, MY;
Patel, KP;
Ricci, F;
Providencia, R;
Chahal, A;
Sohaib, A;
(2024)
Surgical management of atrial fibrillation in patients undergoing cardiac surgery: a systematic review of clinical practice guidelines and recommendations.
European Heart Journal Quality of Care and Clinical Outcomes
, 10
(1)
pp. 14-24.
10.1093/ehjqcco/qcad060.
![[thumbnail of Bebiano Da Providencia E Costa_AF Guidelines systematic review final.pdf]](https://discovery.ucl.ac.uk/style/images/fileicons/text.png) |
Text
Bebiano Da Providencia E Costa_AF Guidelines systematic review final.pdf Access restricted to UCL open access staff until 1 November 2024. Download (173kB) |
Abstract
AIMS: Surgical ablation of atrial fibrillation (AF) has been demonstrated to be a safe procedure conducted concomitantly alongside cardiac surgery. However, there are conflicting guideline recommendations surrounding indications for surgical ablation. We conducted a systematic review of current recommendations on concomitant surgical AF ablation. METHODS AND RESULTS: We identified publications from MEDLINE and EMBASE between January 2011 and December 2022 and additionally searched Guideline libraries and websites of relevant organizations in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 895 studies screened, 4 were rigorously developed (AGREE-II > 50%) and included. All guidelines agreed on the definitions of paroxysmal, persistent, and longstanding AF based on duration and refraction to current treatment modalities. In the Australia-New Zealand (CSANZ) and European (EACTS) guidelines, opportunistic screening for patients >65 years is recommended. The EACTS recommends systematic screening for those aged >75 or at high stroke risk (Class IIa, Level B). However, this was not recommended by American Heart Association or Society of Thoracic Surgeons guidelines. All guidelines identified surgical AF ablation during concomitant cardiac surgery as safe and recommended for consideration by a Heart Team with notable variation in recommendation strength and the specific indication (three guidelines fail to specify any indication for surgery). Only the STS recommended left atrial appendage occlusion (LAAO) alongside surgical ablation (Class IIa, Level C). CONCLUSION: Disagreements exist in recommendations for specific indications for concomitant AF ablation and LAAO, with the decision subject to Heart Team assessment. Further evidence is needed to develop recommendations for specific indications for concomitant AF procedures and guidelines need to be made congruent.
| Type: | Article |
|---|---|
| Title: | Surgical management of atrial fibrillation in patients undergoing cardiac surgery: a systematic review of clinical practice guidelines and recommendations |
| Location: | England |
| DOI: | 10.1093/ehjqcco/qcad060 |
| Publisher version: | https://doi.org/10.1093/ehjqcco/qcad060 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Atrial fibrillation, Cardiac surgery, Guidelines, Surgical ablation, United States, Humans, Atrial Fibrillation, Cardiac Surgical Procedures, Thoracic Surgery, Stroke, Australia |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10191361 |
Archive Staff Only
 |
View Item |
