The following is a summary of the “Barriers to atrial fibrillation ablation during mitral valve surgery,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Mehaffey, et al.
Despite recommendations from the medical community, nearly 40% of patients with AF who are scheduled for mitral valve surgery do not undergo concomitant ablation. They surveyed cardiac surgeons from two state-wide quality collaboratives to determine what was in the way of adopting this best practice based on the available evidence. Around two state-wide groups of adult cardiac surgeons were polled about their experience and education levels in AF ablation. They included questions about your prior knowledge, clinical experience, hypothetical situations, and potential roadblocks to your organization’s implementation.
Around 66 people filled out the survey (66 out of 135 or 48.9%), and the vast majority of them said they were “very comfortable with” or “frequently used” cryoablation (80.3%) and radiofrequency (83.1%). Only 12.1% (8/66) needed to know more about the suggestions. About 50% (33 of 66) or 47.0% (31 of 66) of the respondents said they had learned about AF ablation during their fellowship or through courses. The wide range of responses to clinical scenarios reflected a diversity of practice patterns.
Around Half of those polled said they encountered no difficulties; those who did cite factors like longer cross-clamp times, higher patient risks, and more frequent arrhythmias. Support from cardiology and electrophysiology, protocols, pacemaker rate data, and education via site visits, videos, and proctors were all mentioned as desirable interventions. The extent to which people are aware of and adhere to evidence-based recommendations and patterns of practice varies greatly. Concurrent AF ablation is impeded by several factors that can be addressed with the help of the information presented here.
Source: sciencedirect.com/science/article/abs/pii/S0022522321005183