Table 1. Included studies.
| First author (year) | N | CA | SA | Study type | Mean follow-up | Outcome(s) | Inclusion criteria | Exclusion criteria |
|---|---|---|---|---|---|---|---|---|
| Stulak (18) (2011) | 291 | 194 | 97 | Case-control | 5.6 yrs (median) (SA); 3.1 yrs (CA) |
❖Freedom from atrial fibrillation; ❖Freedom from atrial fibrillation without anti arrhythmic. Measured by reviewing ECG and 24 h Holter monitor data |
SA: Cox-Maze III from lone AF between Jan 1993 and Dec 2007; CA: catheter ablation for AF during the same period. Patients matched 1:2 according to age, sex and AF type |
None specified |
| Boersma (16) (2011) | 124 | 63 | 61 | RCT | 2 yrs | Freedom from left atrial arrhythmia (lasting >30 secs) without anti-arrhythmic drugs | Antiarrhythmic refractory AF, with LA dilatation and hypertension or failed prior CA | Longstanding AF >1 yr, cardiac CA or a surgical cardiac procedure in last 3 months, previous stroke/TIA, LA thrombus, LA diameter >65 mm, LVEF <45%, MR or AR > grade 2, mod/severe AS or MS, active infection or sepsis, pregnancy, unstable angina, MI in last 3 months, AF secondary to electrolyte imbalance, thyroid disease or other reversible or non-cardiac AF cause, history of blood clotting abnormalities, known sensitivity to heparin or warfarin, life expectancy <12 months, involvement in another clinical study, pleural adhesions, prior thoracotomy, prior cardiac surgery and elevated hemidiaphragm |
| Wang (19) (2011) | 166 | 83 | 83 | Pair-matched case-control | 1 yr to 3.6 yrs | Freedom from AF lasting >30 secs; Freedom from anti-arrhythmic drugs |
SA: patients with long-standing persistent AF (>12 non-pharmacological intervention) treated with thoracoscopic surgical ablation. No prior CA. Cases: symptomatic AF refractory to at least 1 class 1 or 3 antiarrhythmic. No prior CA |
SA: LVEF <30%, sick sinus syndrome, severe pleural adhesions, prior attempts at CA. CA: LVEF <30%, LA thrombus on TOE, prior attempts to CA or SA |
| Mahapatra (20) (2011) | 45 | 30 | 15 | Case-control | 30 | Event-free survival of any documented AF recurrence or AAD use | Cases: patients with persistent or long-standing persistent atrial fibrillation who failed at least one catheter ablation and one anti-arrhythmic drug underwent SA Sequential patients were matched to 30 who had previously failed catheter ablation and underwent a repeat catheter ablation |
Any other indication for cardiac surgery, clot in LAA, significant pulmonary hypertension (RV systolic pressure >60 mmHg on TTE), lung disease, less than 18 yrs of age or had a reversible cause of AF |
| Gu (17) (2013) | 95 | 47 | 48 | RCT | 48 | Freedom from recurrence of atrial arrhythmia lasting >30 sec 12-48 months post ablation; Secondary endpoints: incidence of post procedural complications |
Patients with rheumatic heart disease and persistent AF for >1 yr who underwent valvular heart operation from Jan 2006 to Jun 2008 | Paroxysmal AF, non-rheumatic heart disease, left atrial thrombus on TOE, previous AF ablation and valve commissurotomy |
| Krakor (21) (2011) | 112 | 78 | 34 | Cohort | 6 | Freedom from atrial fibrillation at 6 months | Patients undergoing endoscopic mitral valve repair known to have atrial fibrillation; Patients with current AV block or insitu pacemaker were excluded | None specified |
| De Maat (21) (2014) | 99 | 66 | 33 | Case-control | 12 | Freedom from atrial fibrillation at 12 months as measured by Holter monitor | Patients with paroxysmal or short-lasting persistent AF who failed on at least 1 AAD but without prior ablation | Left atrial size >55 mm, prior CA, prior heart or lung surgery, significant coronary disease or previous MI, LVH >12 mm, previous hospitalization for heart failure, LVEF <50%, mod/severe mitral or aortic valve disease, COPD Gold class III-IV or prior TB |
AF, atrial fibrillation; SA, surgical ablation; CA, catheter ablation.