Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?

Abstract

According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“… 952 , 953 These types of continuous ECG monitoring devices have been used in several studies to evaluate the results of surgical or catheter AF ablation. 127 , 607 , 938 , 953 , 954 , 955 , 956 , 957 , 958 , 959 , 960 , 961 Although implantable subcutaneous monitors hold promise for the determination of AF burden in the long term, AF detection algorithms are primarily based on R-R interval regularity, and important limitations include reduced specificity due to undersensing of beats, oversensing of myopotentials, and irregular atrial and ventricular premature beats, as well as limited memory resulting in electrograms not being retrievable to verify the correct rhythm diagnosis. 941 , 944 , 962 Nevertheless, implantable continuous monitors can ameliorate patient compliance issues and provide an assessment of long-term AF burden and late recurrences, including asymptomatic episodes that might have implications for continuation of anticoagulation.…”

The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

“…Left atrial posterior wall isolation, the “box lesion pattern,” is a lesion‐set based on the Cox‐Maze surgical procedure and can be created via catheter, surgical, and hybrid atrial fibrillation ablation. Outcomes from series of both catheter ablation and surgical ablation are generally better when PVI plus left atrial posterior wall isolation is compared with PVI plus only a single roof or floor line. This type of lesion set where ablation lines were added to PVI without “closing the box” were studied in the STAR AF II trial (PVI plus roof and mitral isthmus linear ablation or complex fractionated atrial electrogram ablation) and yielded poor results .…”

Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial

“…The optimal strategy of ablation in these patients remains to be identified. Studies have demonstrated the superiority of the full Cox Maze lesion set as the most effective pattern in maintaining sinus rhythm in persistent AF when lesions are performed surgically with bipolar radiofrequency or cryothermy 16 . However, recent studies in the surgical and catheter field suggest that additional lines, when added to PVI, do not necessarily improve results in patients with persistent AF 13 .…”