Atrial fibrillation cardiac surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Atrial fibrillation}} | {{Atrial fibrillation}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Anahita}} | ||
== | ==Overview== | ||
====Cardiac Surgery—LAA Occlusion/Excision: | 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<ref name="pmid30686041">{{cite journal| author=January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC | display-authors=etal| title=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. | journal=Circulation | year= 2019 | volume= 140 | issue= 2 | pages= e125-e151 | pmid=30686041 | doi=10.1161/CIR.0000000000000665 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30686041 }}</ref> == | |||
=== Recommendation for Cardiac Surgery—LAA Occlusion/Excision Referenced studies that support the modified recommendation are summarized in Online Data Supplement 5 === | |||
{| class="wikitable" style="width: 80%;" | |||
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| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
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| bgcolor="LemonChiffon" |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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki> | |||
|} | |||
==2021 NICE Guideline for the Management of Patients With Atrial Fibrillation <ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue= | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968 }} </ref>== | |||
*Based on NICE guideline updated in 2021 [[Left atrium|left atrial appendage]] occlusion (LAAO) could be considered for [[atrial fibrillation]] [[patients]] who didn't tolerate other [[treatments]] or with [[contraindications]] for [[anticoagulants|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)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>== | |||
===Prevention of Thromboembolism=== | |||
====Cardiac Surgery—LAA Occlusion/Excision==== | |||
{|class="wikitable" style="width: 80%;" | {|class="wikitable" style="width: 80%;" | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Surgical excision of the [[left atrial appendage|left atrial appendage (LAA)]] may be considered in patients undergoing cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[surgery|Surgical]] excision of the [[left atrial appendage|left atrial appendage (LAA)]] may be considered in [[patients]] undergoing [[heart|cardiac]] [[surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | ||
|} | |} | ||
==Sources== | |||
* [http://circ.ahajournals.org/content/early/2014/03/27/CIR.0000000000000041 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation]<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Latest revision as of 02:13, 14 December 2022
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Atrial fibrillation cardiac surgery On the Web | |
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Risk calculators and risk factors for Atrial fibrillation cardiac surgery | |
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.