Evidence map›Paper›PMID 33840467›Full record

ArticleThe Journal of thoracic and cardiovascular surgery2023

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 and 4 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of thoracic and cardiovascular surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Surgical ablation of atrial fibrillation with concomitant cardiac surgery: a state-of-the-art review.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
    Review
  6. Article
  7. Article
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  9. Article
  10. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 7 institutions in 2 countries.

J Hunter MehaffeyDivision of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va. Electronic address: jhm9t@virginia.edu.
Eric J CharlesDivision of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va.
Michaela BerensDivision of Cardiac Surgery, University of Virginia, Charlottesville, Va.
Melissa J ClarkMichigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
Chris BondMichigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
Clifford E FonnerVirginia Cardiac Services Quality Initiative, Falls Church, Va.
Irving KronDivision of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va.
Annetine C GelijnsPopulation Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Marissa A MillerDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.
Eric SarinInova Heart and Vascular Institute, Falls Church, Va.
Matthew RomanoDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Richard PragerMichigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
Vinay BadhwarDepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
Gorav AilawadiMichigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
University of Virginia · USUniversity of Michigan–Ann Arbor · USSociety of Thoracic Surgeons · USAlaska Heart and Vascular Institute · USIcahn School of Medicine at Mount Sinai · USNational Heart Lung and Blood Institute · USWest Virginia University · US

Funding

Network for Cardiothoracic Surgical Investigations in Cardiovascular MedicineUM1HL088925 · NHLBI · UNIVERSITY OF VIRGINIA · PI BADHWAR, VINAY, KRON, IRVING L. · 2013 to 2025
$6.8M
NHLBI NIH HHS UM1 HL088925
6 · The paper itself

Abstract

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.

Indexed as

Atrial FibrillationCardiac Surgical ProceduresCatheter AblationCryosurgeryAdultHumansMitral ValveTreatment Outcomeatrial fibrillationbarriersconcomitant ablationimplementation science

Identifiers

PMID33840467
PMCPMC8446105
OpenAlexW3138579802

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.