The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation

Vinay Badhwar*, J. Scott Rankin, Ralph J. Damiano, A. Marc Gillinov, Faisal G. Bakaeen, James R. Edgerton, Jonathan M. Philpott, Patrick M McCarthy, Steven F. Bolling, Harold G. Roberts, Vinod H. Thourani, Rakesh M. Suri, Richard J. Shemin, Scott Firestone, Niv Ad

*Corresponding author for this work

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Executive Summary Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion)

Original languageEnglish (US)
Pages (from-to)329-341
Number of pages13
JournalAnnals of Thoracic Surgery
Volume103
Issue number1
DOIs
StatePublished - Jan 1 2017

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Practice Guidelines
Atrial Fibrillation
Expert Testimony
Morbidity
Atrial Appendage
Pulmonary Veins
Aortic Valve
Coronary Artery Bypass
Heart Diseases
Transplants
Mortality
Mitral Valve Insufficiency
Therapeutics
Catheters
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Badhwar, V., Rankin, J. S., Damiano, R. J., Gillinov, A. M., Bakaeen, F. G., Edgerton, J. R., ... Ad, N. (2017). The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Annals of Thoracic Surgery, 103(1), 329-341. https://doi.org/10.1016/j.athoracsur.2016.10.076
Badhwar, Vinay ; Rankin, J. Scott ; Damiano, Ralph J. ; Gillinov, A. Marc ; Bakaeen, Faisal G. ; Edgerton, James R. ; Philpott, Jonathan M. ; McCarthy, Patrick M ; Bolling, Steven F. ; Roberts, Harold G. ; Thourani, Vinod H. ; Suri, Rakesh M. ; Shemin, Richard J. ; Firestone, Scott ; Ad, Niv. / The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 1. pp. 329-341.
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abstract = "Executive Summary Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion)",
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Badhwar, V, Rankin, JS, Damiano, RJ, Gillinov, AM, Bakaeen, FG, Edgerton, JR, Philpott, JM, McCarthy, PM, Bolling, SF, Roberts, HG, Thourani, VH, Suri, RM, Shemin, RJ, Firestone, S & Ad, N 2017, 'The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation', Annals of Thoracic Surgery, vol. 103, no. 1, pp. 329-341. https://doi.org/10.1016/j.athoracsur.2016.10.076

The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. / Badhwar, Vinay; Rankin, J. Scott; Damiano, Ralph J.; Gillinov, A. Marc; Bakaeen, Faisal G.; Edgerton, James R.; Philpott, Jonathan M.; McCarthy, Patrick M; Bolling, Steven F.; Roberts, Harold G.; Thourani, Vinod H.; Suri, Rakesh M.; Shemin, Richard J.; Firestone, Scott; Ad, Niv.

In: Annals of Thoracic Surgery, Vol. 103, No. 1, 01.01.2017, p. 329-341.

Research output: Contribution to journalArticle

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AU - Badhwar, Vinay

AU - Rankin, J. Scott

AU - Damiano, Ralph J.

AU - Gillinov, A. Marc

AU - Bakaeen, Faisal G.

AU - Edgerton, James R.

AU - Philpott, Jonathan M.

AU - McCarthy, Patrick M

AU - Bolling, Steven F.

AU - Roberts, Harold G.

AU - Thourani, Vinod H.

AU - Suri, Rakesh M.

AU - Shemin, Richard J.

AU - Firestone, Scott

AU - Ad, Niv

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N2 - Executive Summary Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion)

AB - Executive Summary Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion)

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