Atrial fibrillation cardiac surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Whether left atrial appendage (LAA) occlusion could reduce stroke in patients with AF risk factors who undergo non–AF-related cardiac surgery remains uncertain and larger randomized trials are needed to determine whether LAA ligation could benefit this patient population.
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[1]
Recommendation for Cardiac Surgery—LAA Occlusion/Excision Referenced studies that support the modified recommendation are summarized in Online Data Supplement 5
| Class IIb |
| 1. Surgical occlusion of the LAA may be considered in patients with AF undergoing cardiac surgeryS4.4.2-1, as a component of an overall heart team approach to the management of AF.MODIFIED: LOE was updated from C to B-NR because of new evidence. (Level of Evidence: B-NR) " |
2021 NICE Guideline for the Management of Patients With Atrial Fibrillation [2]
- Based on NICE guideline updated in 2021 left atrial appendage occlusion (LAAO) could be considered for atrial fibrillation patients who didn't tolerate other treatments or with contraindications for anticoagulations.
- Nevertheless this method should not be offered as an alternative to anticoagulants in other patients.
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[3]
Prevention of Thromboembolism
Cardiac Surgery—LAA Occlusion/Excision
| Class IIb |
| "1. Surgical excision of the left atrial appendage (LAA) may be considered in patients undergoing cardiac surgery. (Level of Evidence: C) " |
Sources
References
- ↑ January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC; et al. (2019). "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons". Circulation. 140 (2): e125–e151. doi:10.1161/CIR.0000000000000665. PMID 30686041.
- ↑ Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help). - ↑ 3.0 3.1 January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.