Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va.
Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va.
J Thorac Cardiovasc Surg. 2023 Feb;165(2):650-658.e1. doi: 10.1016/j.jtcvs.2021.03.039. Epub 2021 Mar 17.
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.
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.
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.
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.
尽管社会指南建议，但近 40%的接受二尖瓣手术的房颤 (AF) 患者并未接受同时消融治疗。我们通过对 2 个州立质量合作组织中的心脏外科医生进行调查，评估了实施这一基于证据的实践的障碍。
对 2 个州立合作组织中的成年心脏外科医生进行了关于 AF 消融知识和实践的调查。问题涉及经验、临床实践、案例情景以及实施障碍。
在 66 名受访者（135 名中的 66 名；48.9%）中，大多数报告称“非常熟练/经常使用”冷冻消融术（66 名中的 53 名；80.3%）和射频消融术（66 名中的 55 名；83.3%）。只有 12.1%（8/66）不知道该建议。大约一半的受访者报告在 fellowship 中（50.0%；33/66）或参加课程（47.0%；31/66）中学习过 AF 消融术。对临床情景的回答显示实践模式存在很大差异。一半的受访者表示没有障碍；其他人则认为增加体外循环时间、患者风险过高和心律失常发生率是障碍。所需的干预措施包括心脏病学/电生理学支持、方案、起搏器率信息以及以现场访问、视频和导师形式提供的教育。
对基于证据的建议和实践模式的了解存在很大差异。这些数据确定了同时进行 AF 消融治疗的实施障碍，并提出了克服这些障碍的具体干预措施（指导/支持、方案、研究和教育）。
