Aims: We aimed to compare patients' quality of life (QoL) after two types of atrial fibrillation (AF) treatment: a hybrid ablation strategy and a surgical CryoMaze procedure alone. Methods and results: Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with concomitant CryoMaze procedure were randomly assigned to undergo either radiofrequency catheter ablation after three months (Hybrid Group) or no further treatment (Surgery Group). QoL was compared using the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. The AFEQT score was converted to the scale of 0 to 100 per cent points, i.e., a score of 0 corresponds to complete disability (or responding "extremely" limited, difficult, or bothersome to all questions answered), and a score of 100 corresponds to no disability (or responding "not at all" limited, difficult, or bothersome to all questions answered). In 106 Hybrid Group patients and 109 Surgery Group patients, both baseline and 12-month AFEQT data were available for final analysis. Patients' QoL did not differ between the Hybrid and Surgery Groups at baseline. At 12 months post-procedure, QoL improved significantly in both groups (from 61.9 ± 16.3 to 86.5 ± 13.4 and from 58.6 ± 14.9 to 81.5 ± 16.7 in the Hybrid Group and Surgery Group, respectively, P < 0.001). The 12-month AFEQT score was significantly higher in the Hybrid Group compared to the Surgery Group (P = 0.017). In an analysis based on AF recurrence, the QoL at 12 months was significantly higher in patients without AF recurrences compared to patients with AF recurrences (86.2 ± 14.0 vs 80.2 ± 16.8, P = 0.005). Conclusion: Compared to the CryoMaze procedure alone, the hybrid ablation strategy was associated with higher QoL 12 months post-procedure in patients with non-paroxysmal AF undergoing cardiac surgery for structural heart disease. Arrhythmia recurrence was the most significant denominator of the QoL after concomitant AF surgery.
- Klíčová slova
- CryoMaze,
- MeSH
- fibrilace síní * chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- katetrizační ablace metody škodlivé účinky MeSH
- koronární bypass metody MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- maze procedura * metody MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- statistika jako téma MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
AIMS: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone. METHODS AND RESULTS: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation [Hybrid Group (HG)] or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without class I or III antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding. We analysed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528-1072) days. The primary efficacy endpoint was significantly reduced in the HG [41.1% vs. 67.4%, hazard ratio (HR) = 0.38, 95% confidence interval (CI): 0.26-0.57, P < 0.001] as well as the primary clinical endpoint (19.9% vs. 40.1%, HR = 0.51, 95% CI: 0.29-0.86, P = 0.012). The trial groups did not differ in all-cause mortality (10.6% vs. 8.6%, HR = 1.17, 95%CI: 0.51-2.71, P = 0.71). The major complications of catheter ablation were infrequent (1.9%). CONCLUSION: Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and improved clinical outcomes.
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * diagnóza chirurgie farmakoterapie MeSH
- katetrizační ablace * škodlivé účinky metody MeSH
- krvácení MeSH
- lidé MeSH
- recidiva MeSH
- supraventrikulární tachykardie * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Atrial fibrillation is common in patients with structural heart disease who are undergoing cardiac surgery. Surgical CryoMaze has been shown to be an effective treatment in several trials, but success rates have varied considerably, between 47-95%. The sequential hybrid approach, combining surgical CryoMaze followed by radiofrequency catheter ablation, can achieve high freedom from atrial arrhythmias. However, in patients with concomitant surgical atrial fibrillation treatment, data comparing the hybrid approach to CryoMaze alone are lacking. METHODS: The SurHyb study was designed as a prospective, open-label, multicentre randomized trial. Patients with non-paroxysmal atrial fibrillation who were scheduled for coronary artery bypass grafting or valve repair/replacement were randomized to either surgical CryoMaze alone or surgical CryoMaze followed by radiofrequency catheter ablation 3 months post-surgery. The primary outcome measure was arrhythmia-free survival without class I or III antiarrhythmic drugs, which has been evaluated using implantable cardiac monitors. CONCLUSIONS: This is the first randomized study that compares concomitant surgical CryoMaze alone with the staged hybrid surgical CryoMaze followed by catheter ablation, in patients with non-paroxysmal atrial fibrillation using rigorous rhythm monitoring. The results may contribute to the optimization of the treatment in patients undergoing concomitant CryoMaze for atrial fibrillation.
- MeSH
- antiarytmika terapeutické užití MeSH
- fibrilace síní * chirurgie farmakoterapie MeSH
- kardiochirurgické výkony * metody MeSH
- katetrizační ablace * metody MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- protokol klinické studie MeSH
INTRODUCTION: the use of amplatzer occluder family in daily clinical practice has already overcome on-label indications, with growing clinical experience and the technological evolution of devices. Areas covered: We present the case of a patient with a very rare complication following proximal aortic surgery treated using a unique strategy. A huge pseudoaneurysm around an ascending aortic prosthesis ruptured into the right pulmonary artery. A hybrid treatment strategy consisting of percutaneous closure of the fistula followed by cardiosurgery was chosen due to the patient's poor haemodynamic condition. We also review current clinical experience of endovascular treatment of aortopulmonary fistulas by searching case reports in PubMed. Expert commentary: Closure of the APF using an Amplatzer occluder via the antegrade venous approach is feasible, and may improve the haemodynamic conditions and decrease the risk of subsequent cardiac surgery.
- MeSH
- aortální aneurysma chirurgie MeSH
- aortální stenóza chirurgie MeSH
- arteria pulmonalis abnormality diagnostické zobrazování chirurgie MeSH
- arterioarteriální píštěl diagnostické zobrazování etiologie chirurgie MeSH
- endovaskulární výkony MeSH
- implantace protézy MeSH
- kardiovaskulární chirurgické výkony škodlivé účinky MeSH
- lidé MeSH
- nepravé aneurysma etiologie chirurgie MeSH
- senioři MeSH
- septální okluder * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Autoři prezentují úspěšný případ transkatétrové implantace aortální chlopně (TAVI) u nemocného s hemodynamicky závažnou bikuspidální aortální stenózou s použitím chlopně 2. generace.
The authors present successful TAVI procedure in a patient with bicuspid aortic valve with severe aortic stenosis, employing a second-generation heart valve.
