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When and how to report results of surgery on atrial fibrillation
1Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Linda-A-Velha, Portugal.
Insights
A new scoring system, the Santa Cruz Score, evaluates atrial fibrillation treatment success by assessing rhythm and contraction. This score helps compare various therapies for atrial fibrillation.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Atrial fibrillation (AF) treatments vary in goals and success rates.
- A standardized method is needed to assess and compare AF therapies.
Purpose of the Study:
- To propose a novel methodology and classification for studying and comparing atrial fibrillation treatments.
- Introduce the Santa Cruz Score for evaluating treatment efficacy.
Main Methods:
- Developed the Santa Cruz Score (0-4) based on post-operative atrial rhythm and effective atrial contraction.
- Applied the score to 51 patients undergoing AF surgery (Maze or Pulmonary Vein Isolation) since 1992.
- Assessed patients at multiple time points up to 36 months post-surgery.
Main Results:
- Maze I procedure achieved 88% AF eradication, but no patients scored 4.
- Maze IIIA showed 60% of patients scoring 4, with some score fluctuations.
- Pulmonary Vein Isolation eradicated AF in 71% initially, with 60% at 1 year, and 33% achieving a score of 4.
Conclusions:
- The Santa Cruz Score accounts for intermediate treatment success levels.
- This classification system is applicable across all atrial fibrillation treatment modalities.
Objective:
Several medical, interventional and surgical techniques are used to treat atrial fibrillation, aimed at different goals and having variable success rates. To be able to assess and compare all these techniques a methodology of study and a classification is proposed.
Methods:
We developed a five grade score, named the Santa Crus Score, based upon the post-operative atrial rhythm and the effective atrial contraction. Score 0 corresponds to a persistence of atrial fibrillation, the presence of a regular rhythm is grade 1, 2 or 3 if there is no atrial contraction; right atrial contraction; or bilateral atrial contraction, respectively. Score 4 corresponds to sinus rhythm and bilateral atrial contraction. Surgery for atrial fibrillation was performed on 51 patients since 1992. All patients but two had associated mitrial surgery. Three different maze techniques were performed on 17 patients and the pulmonary veins isolation procedure on 34 patients. Patients were reassessed at 1, 6, 12, 24 and 36 months.
Results:
After the maze I procedure atrial fibrillation eradication was achieved in 88% of patients but none scored 4. Three patients changed score during the first year. All maze III patients scored 0 initially and one changed to score 3 in the first year. Sixty percent of the maze IIIA patients scored 4, but one evolved to score 0 at 6 months. The pulmonary veins isolation technique eliminated atrial fibrillation in 71% of the patients initially, and in 60% after 1 year, and achieved a score of 4 in a third of the patients.
Conclusion:
This classification considers the intermediate grades of success that can occur with absence of atrial fibrillation and is applicable to all forms of therapy.