Surgical ablation during mitral valve surgery significantly increased the rate of sinus rhythm at discharge and >1 year follow-up compared to no ablation, without increasing mortality or stroke.
Meta-Analysis
Does surgical ablation improve sinus rhythm and clinical outcomes in patients with atrial fibrillation undergoing mitral valve surgery?
Surgical ablation during mitral valve surgery significantly increases the rate of sinus rhythm restoration without increasing perioperative or long-term complications.
BACKGROUND: Surgical ablation has emerged as an acceptable treatment modality for patients with atrial fibrillation (AF) undertaking concomitant cardiac surgery. However, the efficacy of surgical ablation in patient populations undergoing mitral valve surgery is not well established. The present meta-analysis aims to establish the current randomized evidence on clinical outcomes of surgical ablation versus no ablative treatment in patients with AF undergoing mitral valve surgery. METHODS: Electronic searches were performed using six databases from their inception to September 2013, identifying all relevant randomized controlled trials (RCTs) comparing surgical ablation versus no ablation in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Nine relevant RCTs were identified for inclusion in the present analysis. The number of patients in sinus rhythm (SR) was significantly improved in the surgical ablation group compared to the non-ablation group at discharge. This effect on SR remained at all follow-up periods until >1 year. Results indicated that there was no significant difference between surgical ablation and no ablation in terms of 30-day mortality, all-cause mortality, pacemaker implantation, stroke, thromboembolism, cardiac tamponade, reoperation for bleeding and myocardial infarction. CONCLUSIONS: Results from the present meta-analysis demonstrate that the addition of surgical ablation for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke and thromboembolism. Further research should be directed at correlating different surgical ablation subtypes to cardiac and cerebrovascular events at long-term follow-up.
Phan et al. (Wed,) conducted a meta-analysis in Atrial fibrillation undergoing mitral valve surgery. Surgical ablation vs. No ablation was evaluated on Sinus rhythm at discharge and follow-up. Surgical ablation during mitral valve surgery significantly increased the rate of sinus rhythm at discharge and >1 year follow-up compared to no ablation, without increasing mortality or stroke.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: