• J. Thorac. Cardiovasc. Surg. · Feb 2023

    Barriers to atrial fibrillation ablation during mitral valve surgery.

    • J Hunter Mehaffey, Eric J Charles, Michaela Berens, Melissa J Clark, Chris Bond, Clifford E Fonner, Irving Kron, Annetine C Gelijns, Marissa A Miller, Eric Sarin, Matthew Romano, Richard Prager, Vinay Badhwar, and Gorav Ailawadi.
    • Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va. Electronic address: jhm9t@virginia.edu.
    • J. Thorac. Cardiovasc. Surg. 2023 Feb 1; 165 (2): 650658.e1650-658.e1.

    BackgroundNearly 40% of patients with atrial fibrillation (AF) undergoing mitral valve surgery do not receive concomitant ablation despite societal guidelines. We assessed barriers to implementation of this evidence-based practice through a survey of cardiac surgeons in 2 statewide quality collaboratives.MethodsAdult cardiac surgeons across 2 statewide collaboratives were surveyed on their knowledge and practice regarding AF ablation. Questions concerning experience, clinical practice, case scenarios, and barriers to implementation were included.ResultsAmong 66 respondents (66 of 135; 48.9%), the majority reported "very comfortable/frequently use" cryoablation (53 of 66; 80.3%) and radiofrequency (55 of 66; 83.3%). Only 12.1% (8/66) were not aware of the recommendations. Approximately one-half of the respondents reported learning AF ablation in fellowship (50.0%; 33 of 66) or attending courses (47.0%; 31 of 66). Responses to clinical scenarios demonstrated wide variability in practice patterns. One-half of the respondents reported no barriers; others cited increased cross-clamp time, excessive patient risk, and arrhythmia incidence as obstacles. Desired interventions included cardiology/electrophysiology support, protocols, pacemaker rate information, and education in the form of site visits, videos and proctors.ConclusionsKnowledge of evidence-based recommendations and practice patterns vary widely. These data identify several barriers to implementation of concomitant AF ablation and suggest specific interventions (mentorship/support, protocols, research, and education) to overcome these barriers.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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