| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Department of Cardiology and Experimental Cardiology, Heart Failure Research Centre, Academic Medical Centre, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
b Department of Cardiothoracic Surgery, Heart Failure Research Center, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
(Email: j.r.degroot{at}amc.uva.nl).
With great interest we read the article by Wang and colleagues [1] on the role of addition of irbesartan in the prevention of atrial fibrillation (AF) recurrence after minimally invasive surgery for AF. Minimally invasive surgery for AF is a new and expanding treatment for AF, and the 93% freedom of AF that the authors report in their patients treated with irbesartan is no less than impressive.
We have some questions regarding the interpretation of the data, which we hope Wang and colleagues [1] will be so kind to clarify for us. The authors state that 93% of 42 patients treated with irbesartan showed no recurrence of AF at the last visit. They also mention that 38 of 42 (which equals 90%) of patients are free from AF, but the Kaplan Meier curves in Figure 2 show a freedom of AF rate of 83% after 6-months follow-up with no further change after that time. Is the time point at which the endpoints were measured perhaps different? To us, it is unclear how many patients were using anti-arrhythmic drugs. Table 3 states that 8 patients in group 1 were still using anti-arrhythmic drugs after 12 months and 4 patients after 48 months, whereas Figure 3 shows a straight line (at 86%) from 6-months follow-up onward.
How long was the maximal follow-up? We understood that patients were followed-up for between 1 and 3.6 years (43 months), but the figures run far beyond 48 months.
With regard to the methods used and complications reported, there are a few things that we did not understand. How did the authors pace the atrium during atrial fibrillation, and why did they pace the ventricle? How many thromboembolic complications were encountered? Was there a stroke as mentioned in the results section, or were there none, as in the discussion? Would it not be advisable to stop warfarin according to the guidelines (ie, continuing it on patients with a high CHADS-VASc score (composed of: Congestive heart failure/LV dysfunction, Hypertension, Age 
75, Diabetes mellitus, Stroke/TIA/Thrombo-embolism, Vascular disease, Age 65–74, Sex category [ie, female sex]), rather than relying on the presumed absence of AF) [2]?
The message that Wang and colleagues [1] convey is clear and encouraging for the use of minimally invasive surgery for the treatment of AF in combination with irbesartan. However, we hope that they can elucidate the difficulties that we had in interpreting their data. The results seem promising but now we are not sure how this article contributes to the evaluation and further understanding of this new treatment.
 |
Acknowledgments |
|---|
 Top Acknowledgments References |
|---|
|
References |
|---|
|
TopAcknowledgmentsReferences |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  J.-G. Wang and X. Meng Reply Ann. Thorac. Surg., January 1, 2012; 93(1): 361 - 362. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
