RECENT REPORTS OF SUCCESS RATES FOR SURGICAL TREATMENT OF AF (MAY 2007)

Here is a summary of some recent reports on surgery for atrial fibrillation from the AATS Convention in Washington DC in May 2007. Its purpose is to give you an very general idea of the outcomes to be expected from surgical approaches. Details such as subject characteristics, invasiveness,  lesions sets and whether they were done as "stand-alone" or concomitant procedures are left out.  Remember that rates for surgeons will vary, so you should always get data on success- and complication rates for the surgeon you are considering -- for your type of AF and physical status,  taking into account the way success is measured and length of follow-up (see the af-ideas.com web site for more on choosing a treatment for your AF and  selecting a surgeon or EP to do it).

Not every well-known surgeon was at the convention. Absent were such notables Dr Dale Geiss and Dr Patrick McCarthy, both of whom reportedly have excellent success rates.

Surgeons treating AF are obviously keeping track of the accomplishments of their EP colleagues, as evidenced by the title of one of the presentations by Ralph Damiano, entitled "Surgery for Lone Atrial Fibrillation: How do we become competitive with catheter ablation?". They are working hard  to develop approaches that are less invasive while retaining the potentially excellent success rates of the Maze procedure.

You will notice that the follow-up periods, with one exception, are very short. Several presenters stressed that what is needed are long-term, randomized studies on various techniques on large groups of patients differing on characteristics that affect prognosis.

The first section presents rates from two top Catheter Ablation ("CA") centers for comparison purposes. This is followed by a section on surgical outcomes. At the end is a brief description of the criteria for recommending surgery vs. CA provided by Dr Niv Ad.

(For additional information on techniques and success rates, see 2008 reviews by Voeller and Gillanov .)

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Catheter Ablation Success-Rate Examples

Please note the short follow-up periods.     Here are results from a world-wide survey of cases between 2003 and 2006:

"Of 16,309 patients with full disclosure of outcome data, 10,488 (median 70.0%; interquartile range 57,7% - 75.4%) became asymptomatic without anti-arrhythmic drugs (AADs) and another 2,047 (10.0%; 0.5% - 17.1%) became asymptomatic in the presence of previously ineffective AADs over 18 (range, 3 - 24) months follow up. Success rates free of AADs and overall success rates were significantly larger in 9,590 patients with paroxysmal AF (74.9% and 83.2%) than in 2,800 patients with persistent AF (64.8% and 75.0%) and 1,108 patients with long-lasting AF (63.1% and 72.3%) (p < 0.0001). Major complications were reported in 741 patients (4.5%)."

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Surgery Success-Rate Examples

PAF=Paroxysmal/Intermittent AF;    

CAF=Permanent/Persistent/Continuous AF;   

FU=Follow-up; NA=not available;

PVI=Pulmonary vein isolation

If the % of Ss that are off medications or other information is not indicated, it was not reported. (Of course being off medication rate is very important to most prospective patients...)

For more on the lesion sets of the following surgeons, see Lesion Set Examples.

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These two reports on the Cox Maze III are presented for the purposes of comparison with newer modifications and other "minimaze" approaches.

http://jtcs.ctsnetjournals.org/cgi/content/full/126/6/1822

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*Dr Gillanov is a well-known surgeon from the Cleveland Clinic (CCF).    Here are rates from a descriptive article he wrote for patients at the CCF web site:

"The Maze procedure has been very successful with a 98% success rate in "lone AF" patients and a 90% success rate overall. Post procedure freedom from stroke has been over 90%."

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Here are the reports from the AATS Convention:

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***This is a high percentage of complications. It must be noted that: 1) Some other presenters did not report complications; and, 2) This sample was very small. The complications reported by Dr Ad are: One re-operation for bleeding, and two permanent pacemakers .

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PVI-Centered "Minimazes"

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Several other surgeons are offering the TT (Totally Thoracoscopic) MiniMaze operations. They are: Dr James Longoria;  Dr John Sirak;

Dr John Pigott; and Dr Bryan Steinberg _____________________________________________________________________________________________________

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This "hybrid" (or "convergent") approach combining epicardial Wolf-type surgery with a CA as needed was not presented at the 2007 AATS meetings, but  should be included in this list

http://www.nmh.org/nmh/heart/inthenews.htm?year=2008&cid=2522

Both Dr Andrea Natale  and Dr Andy Kiser are exploring similar "convergent" procedures", in which surgery and a CA are done with the CA immediately following the surgery.

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This new epicardial approach was not presented at AATS, but may be of some interest because of its ambitious steps for maximizing the probability of success by specifying restrictive endpoints, because of the use of a new instrument for making lesions, and because of the pattern of lesions. The "comprehensive bi-atrial lesion pattern" is designed to be as effective as the Cox III Maze using a different pattern of lesions*:

http://www.ex-maze.com/

*Please see here for some negative comments by Dr James Cox. Apparently, Dr Kiser has turned his interest to the convergent procedure, as above.

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