Event recorder monitoring to compare the efficacy of a left versus biatrial lesion set in patients undergoing concomitant surgical ablation for atrial fibrillation

Pecha, Simon; Hartel, Friederike; Ahmadzade, T; Aydın, Muhammet; Willems, Stephan; Reichenspurner, Hermann; Wagner, Florian Mathias

doi:10.1016/j.jtcvs.2014.02.061

Cited by 13 publications

(17 citation statements)

References 21 publications

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“…In the same study, ablation was associated with an increased risk of implantation of a permanent pacemaker, but authors didn't study the difference between the two lesion sets. In the other hand, Pecha et al [13] in a recent study using the same device employed in our study, a statistically significant higher rate of freedom from atrial fibrillation was observed in patients with a biatrial lesion with lower AF burden. However, they reported a double rate of postoperative pacemaker in patients with biatrial lesion.…”

Section: Discussionsupporting

confidence: 47%

Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

Ali¹,

Lambert²,

Carrier³

et al. 2015

Clin Med Rev Case Rep

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emerged to surgically treat AF [6]. Controversies exist, considering the ideal lesion pattern, regarding the necessity to add right atrial lesions or not to the left atrial lesions. Biatrial lesions have never been compared head to head in a randomized fashion with left atrial maze before the paper of Gilinov for the CTSN investigators [7]. Furthermore, there is a lack of standardization in reporting postoperative results. Most reports indicated the incidence of sinus rhythm on a spot Electrocardiogram (ECG) or 24-hours of continuous cardiac monitoring (CCM) performed at the time a follow-up visit. The use of a reliable technique for continuous monitoring of heart rhythm for over a year postoperatively would allow a more careful evaluation of how prevalent are subclinical forms of atrial fibrillation recurrences [8]. We design this study to evaluate the pattern of recurrence of atrial fibrillation and the AF burden 1 year following mitral surgery comparing the effect of biatrial lesions and left atrial lesions using a continuous monitoring device. Materials and methods This study was approved by the local ethics committee/review board. Informed consent was obtained of each patient. The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. Design of study From January 2011 to December 2012, we prospectively screened all patients planned for mitral valve surgery from degenerative or rheumatic etiology combined or not to Coronary Artery Bypass Graft (CABG) or tricuspid repair. Patients with severe left ventricular dysfunction, complex congenital anomaly, concomitant aortic valve replacement or planned mitral surgery too complex to attempt a biatrial lesion were excluded from the study. All patients with paroxysmal or continuous atrial fibrillation from chart based on ECG or a sinus rhythm with documented atrial size above 45mm on preoperative echocardiogram were selected and allocated into 3 groups regarding their rhythm. All patients were operated by the same surgeon. Patients of each group were randomized to receive left atrial lesion or biatrial lesion or not receive a concomitant AF ablation at time of mitral surgery. Radio frequency ablation procedure AF ablation was achieved through a sternotomy when the mitral

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Section: Discussionsupporting

confidence: 47%

Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

Ali¹,

Lambert²,

Carrier³

et al. 2015

Clin Med Rev Case Rep

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show abstract

“…In a previous published study by our group [23], including only patients with persistent AF, we showed higher rate of freedom from AF in patients receiving biatrial lesion set, compared to those with left atrial lesion set only. We did not find these differences in the present study; however, it has to be admitted that in this study also patients with paroxysmal AF were included.…”

Section: Discussionsupporting

confidence: 45%

Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients

et al. 2015

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Different follow-up methods have been used to report success rates after AF ablation. Recent studies have shown that intermittent rhythm monitoring underestimates the actual AF recurrence rate. We therefore report our experience with continuous rhythm monitoring by implantable loop recorder (ILR) in a large patient cohort. Between 09/2008 and 12/2012, 343 cardiac surgical patients underwent concomitant surgical AF ablation. ILR implantation was performed in 206 patients. ILR interrogation was accomplished at 3, 6 and 12 months postoperatively. Successful ablation was defined as AF Burden <0.5 %. Primary outcome of the study was freedom from AF at 12-month follow-up. Mean patient's age was 70.5 ± 7.4 years. No major ablation- or ILR-related complications occurred. In 4 patients (1.9 %) ILR had to be explanted due to ILR-related wound infection (n = 2) or chronic pain (n = 2). Survival rate at 1-year follow-up was 96.6 %. Freedom from AF rate after 1-year follow-up was 68.5 and 63.6 % off antiarrhythmic drugs, respectively. Statistically significant predictors for successful ablation at 1-year follow-up were smaller LA diameter, shorter duration of AF and preoperative paroxysmal AF. Demographic data, indication for surgery, lesion set and used energy source had no impact on freedom from AF after 1 year. Continuous ILR monitoring after concomitant surgical AF ablation was safe and feasible, with registered freedom from AF rate of 68.5 % at 1-year follow-up. Thus continuous rhythm monitoring provides reliable outcome data and helps to guide antiarrhythmic therapy.

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“…After years of different ablation techniques and lesion sets being tried in concomitant AF operations, evidence supports a biatrial lesion set mimicking the CM-III incisional pattern as the optimal treatment [10,18,19]. At present, most surgeons perform biatrial procedures with linear surgical ablation with radiofrequency or cryoablation.…”

Section: Commentmentioning

confidence: 99%

Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation

Albåge

Johansson

Kennebäck

et al. 2016

The Annals of Thoracic Surgery

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Event recorder monitoring to compare the efficacy of a left versus biatrial lesion set in patients undergoing concomitant surgical ablation for atrial fibrillation

Abstract: Continuous rhythm monitoring by subcutaneous event recorder implantation was safe and feasible. In patients undergoing biatrial ablation, a statistically significant higher rate of freedom from atrial fibrillation was observed at 12 months follow-up.

Cited by 13 publications

References 21 publications

Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

Left Atrial Versus Biatrial Maze Procedures in Atrial Fibrillation: Initial Institutional Randomized Trial with Literature Overview

Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients

Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation

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