Ann Thorac Surg 2007;84:1795. doi:10.1016/j.athoracsur.2007.06.097
© 2007 The Society of Thoracic Surgeons
Correspondence
Guidelines for Reporting Data and Outcomes for the Surgical Treatment of Atrial Fibrillation
Seyed Ahmad Hassantash, MD, FACS,
Behnood Bikdeli, MD,
Shadi Kalantarian, MD,
Maryam Sadeghian, MD,
Farshad Kasraee, MD
Department of Cardiovascular Surgery, Cardiovascular Research Center, Modarres Medical Center, Shaheed Beheshti University of Medical Sciences, Sa’Adat Abat, Tehran 19814, Iran
(Email: sahassan{at}pol.net).
To the Editor:
We appreciate the thoroughness of Shemin and colleagues [1] in preparing a framework for reporting data on the surgical ablation of atrial fibrillation. Most existing studies have not applied uniform descriptions; this endangers comparisons and introduces too much heterogeneity (ie, clinical, methodological, and statistical) into a pooled analysis [2]. These guidelines may prove to be the solution to the current haphazard situation. We have also attempted to adjust our ongoing experience to these guidelines as much as possible [3].
However, we believe that other factors may be added to these guidelines:
- 1 Electrocoagulation should be added to the list of energy sources (in Section E: energy sources used) [4].
- 2 Most authors wish to report the use of the intra-aortic balloon pump, which may be beneficial. In addition, a description of the mean cardiopulmonary bypass time and aortic cross-clamp time may be helpful for describing possible differences in outcomes and complications (both in Section A: description of the surgical procedure).
- 3 Although quality-of-life assessment is noted in the original article, using a more objective and commonplace measure, such as the preoperative use of the New York Heart Association functional classification at specifically defined intervals afterwards is also advisable (in Section L: quality-of-life assessment) [5].
- 4 Levels of the B-type natriuretic peptide (BNP) rise with atrial fibrillation and significantly diminish after successful ablation. This observation has recently attracted much attention [6]. Thus, pre-procedural and regular postoperative assessment of BNP levels seems desirable.
Finally, we believe a uniform standard should replace the widely used "success" after surgery. Some investigators consider sinus rhythm as a successful postoperative result, whereas others accept all atrial rhythms as successful outcomes. Well-defined criteria adapted for P-wave morphologic changes after surgery best define the rhythm success.
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References
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- Shemin RJ, Cox JL, Gillinov AM, Blackstone EH, Bridges CR. Workforce on evidence-based surgery of The Society of Thoracic Surgeons: guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation Ann Thorac Surg 2007;83:1225-1230.[Abstract/Free Full Text]
- Deeks JJ, Higgins JPT, Altman DG. Analysing and presenting resultsIn: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions 4.2.6 [updated September 2006]. Section 8. In: The Cochrane Library, issue 4. Chichester, UK: John Wiley & Sons, Ltd; 2006.
- The cochrane collaboration-cochrane reviews. Available at: http://www.cochrane.org/reviews/en/info_0509FA5382E26AA2017127F4F77BA25C.html. Accessed June 10, 2007.
- de Lima GG, Kalil RA, Leiria TL, et al. Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease Ann Thorac Surg 2004;77:2089-2094discussion 2094–5.[Abstract/Free Full Text]
- Doukas G, Samani NJ, Alexiou C, et al. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial JAMA 2005;294:2323-2329.[Abstract/Free Full Text]
- Wozakowska-Kaplon B. Effect of sinus rhythm restoration on plasma brain natriuretic peptide in patients with atrial fibrillation Am J Cardiol 2004;93:1555-1558.[Medline]
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