Atrial fibrillation (Afib) is the most
common type of irregular heartbeat. Afib can lead to blood clots, strokes, heart failure, and other
heart-related complications. According to the American Heart Association
(AHA), untreated Afib doubles the risk of heart-related deaths and is
associated with a significantly increased risk for stroke. At least 2.7
million Americans are living with Afib.
One option for Afib treatment is surgical ablation, also known as the maze procedure. When
performing surgical ablation, the surgeon makes very specific and
defined lesions in the heart. Scar tissue forms, blocking the abnormal
electrical signals while also creating a controlled path for electricity
in the heart to follow. The heartbeat should eventually normalize.
‘The newly issued guidelines highlights the increasing global evidence on the safety and efficacy of surgical ablation for the treatment of atrial fibrillation.’
New clinical practice guidelines have been issued by The Society of
Thoracic Surgeons (STS) that include major recommendations for the use
of surgical ablation when treating atrial fibrillation (Afib).
The guidelines, posted online today
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," said guidelines co-author Vinay Badhwar, Gordon F.
Murray Professor and Chair of the West Virginia University Heart &
Vascular Institute. "This important document highlights the increasing
global evidence on the safety and efficacy of surgical ablation for the
treatment of Afib."
STS believes that the practice of summarizing current scientific
evidence into clinical practice guidelines and recommendations may
contribute importantly to improving surgical outcomes, as well as the
quality of patient care. In this case, the literature revealed that
surgical ablation as a treatment option for Afib 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 Afib and
improving quality of life, and so deserves a more prominent role in
adult cardiac surgery.
In patients with Afib, rapid, disorganized electrical signals cause
the two upper parts of the heart (the atria) to quiver. The quivering
upsets the normal rhythm between the atria and the lower parts of the
heart (the ventricles). As a result, the ventricles may beat fast and
without a regular rhythm.
"It is recognized that surgical ablation impacts long-term outcomes
with improvements in normal heart rhythm, quality of life, and stroke
reduction," said Dr. Badhwar. "Current evidence reveals that surgical
ablation can be performed without significant impact to major
complications or death."
Surgical ablation can be done as a standalone procedure or in
combination with another heart surgery. 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
The new clinical practice guidelines offer evidence-based recommendations that include:
- Surgical ablation for Afib at the time of concomitant mitral operations to restore cardiac rhythm;
- Surgical ablation for Afib at the time of concomitant isolated
AVR, isolated CABG, and AVR+CABG operations to restore cardiac rhythm;
- Surgical ablation as a primary standalone procedure to
restore cardiac rhythm for symptomatic Afib 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 Afib.
"These guidelines may help guide surgeons when faced with a
challenging decision on the management of Afib," said Dr. 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."