What is the real atrial fibrillation burden after catheter ablation of atrial fibrillation? A prospective rhythm analysis in pacemaker patients with continuous atrial monitoring

Steven, Daniel; Rostock, Thomas; Lutomsky, Boris; Klemm, Hanno; Servatius, Helge; Drewitz, Imke; Friedrichs, Kai; Ventura, Rodolfo; Meinertz, Thomas; Willems, Stephan

doi:10.1093/eurheartj/ehn024

Cited by 81 publications

(56 citation statements)

References 18 publications

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“…Recent publications concentrate on the precision of detecting symptomatic, as well as asymptomatic, attacks of arrhythmia in patients following radiofrequency catheter ablation for paroxysmal and persistent AF [31][32][33][34][35] (there are practically no data concerning the occurrence of AF episodes using long-term ECG monitoring after surgical ablation of paroxysmal, persistent and permanent AF available). The techniques used include a trans-telephone ECG monitoring, sevenday Holter monitoring and continuous ECG monitoring either with sophisticated pacemakers and cardioverters -defibrillators (application of their Holter functions), or with implantable loop recorders (Reveal, Medtronic Inc., Minneapolis, Minnesota).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Kolek¹,

Brát²

2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of this prospective study was to assess the presence of sinus rhythm and atrial transport function after surgical ablation of atrial fibrillation using cryoenergy, and to evaluate predictors of the success of the procedure.Methods. Between January 2005 and September 2006, 100 consecutive patients underwent left atrial cryoablation as a concomitant surgical procedure (46 patients with paroxysmal or persistent atrial fibrillation and 54 with permanent atrial fibrillation). Mitral valve surgery was performed in 74%. The mean and the median times of follow-up were 20 ± 8.5, and 24 months respectively. Atrial mechanical function was assessed by echocardiography.Results. Sinus rhythm was achieved during the postoperative follow-up in 71-81% of patients -significantly more often in the group with paroxysmal and persistent atrial fibrillation (90-98%), than patients with permanent atrial fibrillation prior to surgery (51-65%) (p<0.002). At 12 and 24 months after the surgery, a total of 68.2% and 51.2% of the patients were free from atrial fibrillation; 73.9% and 60.7% of the patients from the paroxysmal and persistent atrial fibrillation group, and 60.3% and 37.7% of patients with permanent atrial fibrillation (p=0.05). Five per cent of patients required postoperative permanent pacemaker implantation. An effective left and right atrial mechanical function was detected in 70-90%, and 96-98% of patients with sinus rhythm respectively. The following circumstances were identified as negative predictors of the presence of sinus rhythm after the ablation procedure: growing diameter of the left atrium, the duration of atrial fibrillation and the severity of mitral and tricuspid regurgitation before surgery (p<0.05). Restoration of the left atrial transport function was negatively predicted by the preoperative diameter of the left atrium, the presence of mitral valve stenosis and the severity of tricuspid regurgitation (p<0.05). A total of 95.4% of patients were free from stroke at one-year follow-up, and 94.1% at 2 years after surgery.Conclusion. Stable sinus rhythm and effective left atrial transport function are the main factors resulting in decreased morbidity after successful ablation of atrial fibrillation. A careful post-operative follow-up of the patients and individualised treatment are necessary.

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Section: Discussionmentioning

confidence: 99%

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Kolek¹,

Brát²

2010

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Although relatively infrequent in this meta-analysis, observational data suggest that repeat ablation is required in 20% to 40% of patients. 21,22 The lower incidence of repeat ablation in this meta-analysis compared with the observational studies probably reflects the experience of these referral centers and the limited follow-up (12 months) in the trials. Among patients randomly assigned to medical therapy, more than half crossed over to catheter ablation, highlighting the limitations of antiarrhythmic drug therapy.…”

Section: Efficacy Of Pvimentioning

confidence: 91%

Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

Piccini

Lópes

Kong

et al. 2009

Circ: Arrhythmia and Electrophysiology

253

140

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Background-Catheter ablation is an established yet evolving nonpharmacologic intervention for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). The efficacy and safety of pulmonary vein isolation (PVI) compared with medical therapy remain in question. Methods and Results-We conducted a meta-analysis of all randomized, controlled trials comparing PVI and medical therapy for the maintenance of sinus rhythm. The primary end point in this analysis was freedom from recurrent AF at 12 months. The relative efficacy of PVI was estimated using random-effects modeling according to intention to treat. We identified 6 trials that randomized a total of 693 patients with AF to PVI or control. PVI was associated with markedly increased odds of freedom from AF at 12 months of follow-

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“…Because all patients did receive 24HM, this entity should have been captured by the examiners. 14 We could not always provide a simultaneous 24HM for every time point of our study. This, in our opinion, mirrors the real-life of patient compliance in accepting 24HM routine follow-up.…”

Section: Study Limitationsmentioning

confidence: 99%

Twenty-Four–Hour Holter Monitor Follow-Up Does Not Provide Accurate Heart Rhythm Status After Surgical Atrial Fibrillation Ablation Therapy

et al. 2009

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Background-Twenty-four-hour Holter monitoring (24HM) is commonly used to assess cardiac rhythm after surgical therapy of atrial fibrillation (AF). However, this "snapshot" documentation leaves a considerable diagnostic window and only stores short-time cardiac rhythm episodes. To improve accuracy of rhythm surveillance after surgical ablation therapy and to compare continuous heart rhythm surveillance versus 24HM follow-up intraindividually, we evaluated a novel implantable continuous cardiac rhythm monitoring (IMD) device (Reveal XT 9525). Methods and Results-Forty-five cardiac surgical patients (male 37, mean age 69.7Ϯ9.2 years) with a mean preoperative AF duration of 38Ϯ45 m were treated with either left atrial epicardial high-intensity focus ultrasound ablation (nϭ33) or endocardial cryothermy (nϭ12) in case of concomitant mitral valve surgery. Rhythm control readings were derived simultaneously from 24HM and IMD at 3-month intervals with a total recording of 2021 hours for 24HM and 220 766 hours for IMD. Mean follow-up was 8.30Ϯ3.97 m (range 0 to 12 m). Mean postoperative AF burden (time period spent in AF) as indicated by IMD was 37Ϯ43%. Sinus rhythm was documented in 53 readings of 24HM, but in only 34 of these instances by the IMD in the time period before 24HM readings (64%, PϽ0.0001), reflecting a 24HM sensitivity of 0.60 and a negative predictive value of 0.64 for detecting AF recurrence. Conclusion-For "real-life" cardiac rhythm documentation, continuous heart rhythm surveillance instead of any conventional 24HM follow-up strategy is necessary. This is particularly important for further judgment of ablation techniques, devices as well as anticoagulation and antiarrhythmic therapy. (Circulation. 2009;120[suppl 1]:S177-S184.)

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What is the real atrial fibrillation burden after catheter ablation of atrial fibrillation? A prospective rhythm analysis in pacemaker patients with continuous atrial monitoring

Cited by 81 publications

References 18 publications

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Cardiac Rhythm and Atrial Transport Function After Surgical Ablation of Atrial Fibrillation Using Cryoenergy: Predictors and Effectiveness of the Procedure

Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

Twenty-Four–Hour Holter Monitor Follow-Up Does Not Provide Accurate Heart Rhythm Status After Surgical Atrial Fibrillation Ablation Therapy

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