TY - JOUR
T1 - Barriers to atrial fibrillation ablation during mitral valve surgery
AU - Mehaffey, J. Hunter
AU - Charles, Eric J.
AU - Berens, Michaela
AU - Clark, Melissa J.
AU - Bond, Chris
AU - Fonner, Clifford E.
AU - Kron, Irving
AU - Gelijns, Annetine C.
AU - Miller, Marissa A.
AU - Sarin, Eric
AU - Romano, Matthew
AU - Prager, Richard
AU - Badhwar, Vinay
AU - Ailawadi, Gorav
N1 - Funding Information:
This study was funded by the Cardiothoracic Surgical Trials Network Grant for Implementation Science (Grant UM1HL088925, to J.H.M.). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.
Funding Information:
This study was funded by the Cardiothoracic Surgical Trials Network Grant for Implementation Science (Grant UM1HL088925 , to J.H.M.). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung and Blood Institute, the National Institutes of Health, or the US Department of Health and Human Services.
Publisher Copyright:
© 2021 The American Association for Thoracic Surgery
PY - 2023/2
Y1 - 2023/2
N2 - Background: Nearly 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. Methods: Adult 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. Results: Among 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. Conclusions: Knowledge 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.
AB - Background: Nearly 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. Methods: Adult 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. Results: Among 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. Conclusions: Knowledge 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.
KW - atrial fibrillation
KW - barriers
KW - concomitant ablation
KW - implementation science
UR - http://www.scopus.com/inward/record.url?scp=85103988756&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2021.03.039
DO - 10.1016/j.jtcvs.2021.03.039
M3 - Article
AN - SCOPUS:85103988756
SN - 0022-5223
VL - 165
SP - 650-658.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -