Updated interpretation of the 2024 ESC guidelines for the management of atrial fibrillation: Surgical management of atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Qiyue ^1,2 , SUN Yiren ² ,  QIAN Yongjun ²

1. First School of Clinical Medicine, Mudanjiang Medical University, Mudanjiang, 157011, Heilongjiang, P. R. China;
2. Department of Cardiovascular Surgery, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Atrial fibrillation; surgical treatment; diagnosis; guidance interpretation

DOI：

10.7507/1007-4848.202410059

Video：

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Abstract Full text Figures/Tables Video References Cited by

The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have recently updated and published the 2024 ESC guidelines for the management of atrial fibrillation. Based on the latest evidences, the guidelines have been updated in many aspects, such as diagnostic criteria for atrial fibrillation, AF-CARE treatment principles, comorbidities and risk factor management. In particular, there are significant changes in the recommendations for surgical management of atrial fibrillation in the guidelines. Therefore, this paper aims to interpret the content updates of the guidelines in AF-CARE treatment principles, diagnostic criteria and surgical treatment of atrial fibrillation, especially highlighting the updates and new suggestions about surgical treatment of atrial fibrillation.

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2. Chung MK, Refaat M, Shen WK, et al. Atrial fibrillation: JACC council perspectives. J Am Coll Cardiol, 2020, 75(14): 1689-1713.
3. Brundel BJJM, Ai X, Hills MT, et al. Atrial fibrillation. Nat Rev Dis Primers, 2022, 8(1): 21.
4. Wang A, Green JB, Halperin JL, et al. Atrial fibrillation and diabetes mellitus: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(8): 1107-1115.
5. Alijla F, Buttia C, Reichlin T, et al. Association of diabetes with atrial fibrillation types: A systematic review and meta-analysis. Cardiovasc Diabetol, 2021, 20(1): 230.
6. Ding WY, Kotalczyk A, Boriani G, et al. Impact of diabetes on the management and outcomes in atrial fibrillation: An analysis from the ESC-EHRA EORP-AF Long-Term General Registry. Eur J Intern Med, 2022, 103: 41-49.
7. Kadhim K, Middeldorp ME, Elliott AD, et al. Prevalence and assessment of sleep-disordered breathing in patients with atrial fibrillation: A systematic review and meta-analysis. Can J Cardiol, 2021, 37(11): 1846-1856.
8. Moula AI, Parrini I, Tetta C, et al. Obstructive sleep apnea and atrial fibrillation. J Clin Med, 2022, 11(5): 1242.
9. Overvad TF, Rasmussen LH, Skjøth F, et al. Alcohol intake and prognosis of atrial fibrillation. Heart, 2013, 99(15): 1093-1099.
10. Lim C, Kim TH, Yu HT, et al. Effect of alcohol consumption on the risk of adverse events in atrial fibrillation: From the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry. Europace, 2021, 23(4): 548-556.
11. Bisbal F, Baranchuk A, Braunwald E, et al. Atrial failure as a clinical entity: JACC review topic of the week. J Am Coll Cardiol, 2020, 75(2): 222-232.
12. Freedman B, Lowres N. High-intensity atrial fibrillation screening to prevent stroke. Lancet, 2021, 398(10310): 1465-1467.
13. Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2024, 45(36): 3314-3414.
14. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
15. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
16. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure: Assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11): 924-929.
17. Ramlawi B, Abu Saleh WK, Edgerton J. The left atrial appendage: Target for stroke reduction in atrial fibrillation. Methodist Debakey Cardiovasc J, 2015, 11(2): 100-103.
18. Wolf PA, Dawber TR, Thomas HE, et al. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham study. Neurology, 1978, 28(10): 973-977.
19. Krahn AD, Manfreda J, Tate RB, et al. The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med, 1995, 98(5): 476-484.
20. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke, 1991, 22(8): 983-988.
21. Güner A, Kalçık M, Gündüz S, et al. The relationship between incomplete surgical obliteration of the left atrial appendage and thromboembolic events after mitral valve surgery (from the ISOLATE Registry). J Thromb Thrombolysis, 2021, 51(4): 1078-1089.
22. Whitlock RP, Belley-Cote EP, Paparella D, et al. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med, 2021, 384(22): 2081-2091.
23. Boersma LV, Castella M, van Boven W, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): A 2-center randomized clinical trial. Circulation, 2012, 125(1): 23-30.
24. Kvist LM, Vinter N, Urbonaviciene G, et al. Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers. Open Heart, 2019, 6(1): e000942.
25. Hijazi Z, Oldgren J, Siegbahn A, et al. Biomarkers in atrial fibrillation: A clinical review. Eur Heart J, 2013, 34(20): 1475-1480.
26. Berg DD, Ruff CT, Morrow DA. Biomarkers for risk assessment in atrial fibrillation. Clin Chem, 2021, 67(1): 87-95.
27. Tops LF, Schalij MJ, Bax JJ. Imaging and atrial fibrillation: The role of multimodality imaging in patient evaluation and management of atrial fibrillation. Eur Heart J, 2010, 31(5): 542-551.
28. Obeng-Gyimah E, Nazarian S. Advancements in imaging for atrial fibrillation ablation: Is there a potential to improve procedural outcomes? J Innov Card Rhythm Manag, 2020, 11(7): 4172-4178.
29. Romero J, Husain SA, Kelesidis I, et al. Detection of left atrial appendage thrombus by cardiac computed tomography in patients with atrial fibrillation: A meta-analysis. Circ Cardiovasc Imaging, 2013, 6(2): 185-194.
30. Bisbal F, Benito E, Teis A, et al. Magnetic resonance imaging-guided fibrosis ablation for the treatment of atrial fibrillation: The ALICIA trial. Circ Arrhythm Electrophysiol, 2020, 13(11): e008707.
31. Khurram IM, Habibi M, Gucuk Ipek E, et al. Left atrial LGE and arrhythmia recurrence following pulmonary vein isolation for paroxysmal and persistent AF. JACC Cardiovasc Imaging, 2016, 9(2): 142-148.
32. Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: The DECAAF study. JAMA, 2014, 311(5): 498-506.
33. Roney CH, Sillett C, Whitaker J, et al. Applications of multimodality imaging for left atrial catheter ablation. Eur Heart J Cardiovasc Imaging, 2021, 23(1): 31-41.
34. Potter A, Augustine DX, Ingram TE. Referring for echocardiography: When not to test. Br J Gen Pract, 2021, 71(708): 333-334.
35. Tsai YC, Phan K, Munkholm-Larsen S, et al. Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: A meta-analysis. Eur J Cardiothorac Surg, 2015, 47(5): 847-854.
36. Whitlock RP, Vincent J, Blackall MH, et al. Left atrial appendage occlusion study Ⅱ (LAAOS Ⅱ). Can J Cardiol, 2013, 29(11): 1443-1447.
37. Cartledge R, Suwalski G, Witkowska A, et al. Standalone epicardial left atrial appendage exclusion for thromboembolism prevention in atrial fibrillation. Interact Cardiovasc Thorac Surg, 2022, 34(4): 548-555.
38. Heuts S, H Heijmans J, La Meir M, et al. Does left atrial appendage exclusion by an epicardial clipinfluence left atrial hemodynamics? Pilot results of invasive intra-cardiac measurements. J Atr Fibrillation, 2021, 14(1): 20200479.
39. Starck CT, Steffel J, Emmert MY, et al. Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Interact Cardiovasc Thorac Surg, 2012, 15(3): 416-418.
40. Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol, 2018, 72(12): 1346-1353.
41. van Laar C, Verberkmoes NJ, van Es HW, et al. Thoracoscopic left atrial appendage clipping: A multicenter cohort analysis. JACC Clin Electrophysiol, 2018, 4(7): 893-901.
42. Toale C, Fitzmaurice GJ, Eaton D, et al. Outcomes of left atrial appendage occlusion using the AtriClip device: A systematic review. Interact Cardiovasc Thorac Surg, 2019, 29(5): 655-662.
43. Caliskan E, Sahin A, Yilmaz M, et al. Epicardial left atrial appendage AtriClip occlusion reduces the incidence of stroke in patients with atrial fibrillation undergoing cardiac surgery. Europace, 2018, 20(7): e105-e114.
44. Branzoli S, Guarracini F, Marini M, et al. Heart team for left atrial appendage occlusion: A patient-tailored approach. J Clin Med, 2021, 11(1): 176.
45. Kim HJ, Kim YJ, Kim M, et al. Surgical ablation for atrial fibrillation during aortic and mitral valve surgery: A nationwide population-based cohort study. J Thorac Cardiovasc Surg, 2024, 167(3): 981-993.
46. Maesen B, Luermans JGLM, Bidar E, et al. A hybrid approach to complex arrhythmias. Europace, 2021, 23(23 Suppl 2): ii28-ii33.
47. van der Heijden CAJ, Vroomen M, Luermans JG, et al. Hybrid versus catheter ablation in patients with persistent and longstanding persistent atrial fibrillation: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2019, 56(3): 433-443.
48. Castellá M, Kotecha D, van Laar C, et al. Thoracoscopic vs. catheter ablation for atrial fibrillation: Long-term follow-up of the FAST randomized trial. Europace, 2019, 21(5): 746-753.
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Latest ArticlesUpdated interpretation of the 2024 ESC guidelines for the management of atrial fibrillation: Surgical management of atrial fibrillation

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