ESC Congress FA eBook 2016 - 9

Your FREE access to
ESC Congress content
all year long
www.escardio.org/365

Figure 4. View of Left and Right Atrial Lesions in Bilateral Cox
Maze Surgery*

*Left atrial lesions, left panel; right atrial lesions, middle and right panels.
Reprinted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation
developed in collaboration with EACTS. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw210.
By permission of Oxford University Press on behalf of the European Society of Cardiology.

as the biatrial Cox Maze III/IV procedure (Figure 4).
The guidelines recommend that maze surgery, preferably biatrial, should be considered for patients undergoing cardiac surgery to improve symptoms attributable to
AF, balancing the added risk of the procedure and the
benefit of rhythm control therapy. Concomitant biatrial
maze surgery or pulmonary vein isolation may be considered in asymptomatic AF patients undergoing cardiac
surgery. The guidelines also recommend considering
surgical isolation of the left atrial appendage, although
OAC should be continued in patients at risk of stroke.
Thoracoscopic, minimally invasive Maze surgery is
now available in selected countries. Results from the

ESC CONGRESS 2016
IN REVIEW

FOCUS ON ARRHYTHMIAS

FAST trial [Boersma L et al. Circulation. 2012] suggested
that thoracoscopic AF ablation could be more effective
than catheter ablation for maintaining sinus rhythm ,
but further study is needed on long-term outcomes and
complication rates (which include conversion to sternotomy (0%-1.6%), pacemaker implantation (0%-3.3%),
drainage for pneumothorax (0%-3.3%), pericardial tamponade (0%-6.0%), and TIA (0%-3.0%).
The recommendations for catheter and surgical ablation for patients with persistent or post-ablation AF are
shown in Table 8.
Throughout the 2016 AF guidelines, the ESC emphasizes
the importance of patient-centered care, integrated patient
education, self-management, and shared decision-making.
Informed patients who are aware of their own responsibilities for managing their disease are more likely to comply
with therapy. Shared decision-making that respects patient
preferences empowers patients and tends to improve
health outcomes and care experiences (Table 9).
The 2016 AF guidelines also include an integrated
treatment manger as part of the free ESC Pocket
Guidelines app for iOS and Android devices, and specific
apps for patients and healthcare providers will follow in
late 2016/early 2017.
These tools were developed by CATCH ME, a Horizon
2020 funded project under grant number 633196.

Table 8. Recommendations for Catheter and Surgical Ablation for Patients With Persistent or Post-ablation AF
Recommendations

Class

Level

Catheter or surgical ablation should be considered in patients with symptomatic persistent or long-standing persistent
AF refractory to AAD therapy to improve symptoms, considering patient choice, benefit and risk, supported by an AF
Heart Team.

IIa

Minimally invasive surgery with epicardial pulmonary vein isolation should be considered in patients with symptomatic
AF when catheter ablation has failed. Decisions on such patients should be supported by an AF Heart Team.

IIa

Maze surgery, possibly via a minimally invasive approach, performed by an adequately trained operator in an
experienced center, should be considered by an AF Heart Team as a treatment option for patients with symptomatic
refractory persistent AF or postablation AF to improve symptoms.

IIa

AAD, antiarrhythmic drug; AF, atrial fibrillation.
Adapted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw210. By
permission of Oxford University Press on behalf of the European Society of Cardiology.

Table 9. Recommendations for Patient Involvement, Education, and Self-Management
Recommendations

Class

Level

Patient involvement in the care process should be considered to encourage self-management and responsibility for
lifestyle changes.

IIa

Shared decision making should be considered to ensure that care is based on the best available evidence preferences
of the patient and fits the needs, values and preferences of the patient.

IIa

Tailored patient education is recommended in all phases of AF management to support patients' perception of AF and
to improve management.

Reprinted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw210. By
permission of Oxford University Press on behalf of the European Society of Cardiology.

Official Peer-Reviewed Highlights From ESC Congress 2016

http://www.escardio.org/365

Table of Contents for the Digital Edition of ESC Congress FA eBook 2016