Outcomes of concomitant surgical ablation in patients undergoing surgical myectomy for hypertrophic obstructive cardiomyopathy: A systematic review and meta-analysis

https://doi.org/10.1016/j.ijcard.2023.05.049Get rights and content
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Highlights

  • This is the first systematic review and meta-analysis aimed to evaluate efficacy, survival benefit and safety of concomitant surgical AF ablation in HOCM patients undergoing surgical septal myectomy.

  • Concomitant surgical AF ablation during septal myectomy seems to be safe and effective on short- and long-term

  • Survival and freedom from recurrent AF at 7 years were 90.5% and 63.2%, respectively

Abstract

Objective

Studies investigating the efficacy of concomitant surgical atrial fibrillation (AF) ablation in hypertrophic obstructive cardiomyopathy (HOCM) patients undergoing myectomy are scarce and limited in terms of sample size. We aim to summarize current outcomes of concomitant surgical AF ablation in HOCM patients undergoing surgical myectomy.

Methods

This systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all studies reporting any of the following outcomes of concomitant surgical AF ablation in HOCM patients: freedom from recurrence of AF, overall survival and complications. Outcomes were evaluated using traditional meta-analysis at given time-points and using pooled Kaplan-Meier curves.

Results

A total of 13 studies were included, resulting in a total of 616 individual patients available for analysis. AF was paroxysmal in 68.1% of the patients (95% CI 56.0–78.2%; I2 = 87.1%; 8 studies, 583 participants). The majority of patients (86.2%) underwent either conventional Cox Maze III or IV (95% CI 39.7–98.3%; I2 = 92.4%; 8 studies, 616 patients) procedure. The incidence of early post-operative pacemaker implantation was 6.1% (95% CI 3.1–11.8%). Overall survival at 3, 5 and 7 years was 95.6% (95% CI 93.4–97.9%), 93.6% (95% CI 90.8–96.5%) and 90.5% (95% CI 86.5–94.6%), respectively. Freedom from recurrent AF at 3, 5 and 7 years was 77.6% (95% CI 73.7–81.7%), 70.6% (95% CI 65.8–75.7) and 63.2% (95% CI 56.2–73.8%), respectively.

Conclusion

This meta-analysis supports concomitant surgical AF ablation at the time of surgical myectomy in HOCM patients, as it seems to be safe and effective in terminating AF.

Keywords

Atrial fibrillation
Surgical ablation
Hypertrophic obstructive cardiomyopathy
Myectomy

Abbreviations

AF
atrial fibrillation
HOCM
hypertrophic obstructive cardiomyopathy
LA
left atrium
LAA
left atrial appendage
IPD
individual patient data
PM
pacemaker
RF
radiofrequency

Data availability statement

The data underlying this article are available in the article and in its online supplementary material.

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1

Contributed equally to this work.