RESUMEN
BACKGROUND: Radiofrequency ablation therapy for the treatment of atrial fibrillation (AF) can be performed as a concomitant procedure alongside cardiac surgery, but carries the risks of increased bypass time and damage to the sinoatrial node. This study aims to assess the efficacy of concomitant surgical AF ablation and develop a novel scoring system to predict post-procedural return to sinus rhythm. METHODS: A review of the Leeds General Infirmary surgical database was conducted to list all patients who had undergone valvular or coronary bypass surgery with concomitant AF ablation between Jan 2012 - Dec 2013 (n = 76). Follow-up was obtained retrospectively using patient notes, clinic letters and echocardiographic data. Primary outcome was freedom from AF at median follow up (383 days). A novel scoring system was created through analysis of previous literature and evaluated using a receiver operating characteristic (ROC) curve. RESULTS: At median follow up 50.9% of patients undergoing the procedure were free from AF. The novel scoring system was shown to adequately predict post-procedural return to sinus rhythm (ROC AUC = 0.7708). CONCLUSION: A novel scoring system was shown to predict procedural success in patients undergoing concomitant AF ablation alongside cardiac surgery. These results can be further validated using larger patient cohorts.
RESUMEN
No other form of therapy, whether medical or surgical, has an impact comparable to heart transplantation on the quality of life and survival of selected patients with severe heart failure. In the EU and in the USA about 10 patients per million of population are transplanted each year. In Portugal, a country with a population of 10 million, 100 patients should be transplanted each year, but only 12 patients were in fact transplanted in 1999. We rank 17th, in terms of the rate of heart transplantation per million of population, among the 23 European countries with registries of this activity. This is due to structural and organizational deficiencies of three main types: the lack of professional teams dedicated to severe heart failure treatment and heart transplantation; the lack of infrastructure, particularly heart failure wards and heart failure outpatient clinics; and the inappropriate distribution of the tasks associated with heart transplantation and patient follow-up. We present an estimate of the number of potential heart transplant candidates in Portugal, based on the EPICA study and a prediction of the resources needed for a successful heart transplantation program serving a population of 2 million. This was based on what is known of the natural history, morbidity and mortality of severe heart failure, on our own experience in this field, and finally on the experience of a large international heart transplantation center. The recommendations of the British Transplantation Society and those of the Department of Cardiothoracic Surgery of Stanford University were also taken into account.
