title: The efficacy of intraoperative atrial radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery-the Surgical Atrial Fibrillation Suppression (SAFS) Study.
abstract: BACKGROUND
  Studies assessing radiofrequency ablation (RFA) for atrial fibrillation (AF) performed at the time of concomitant cardiac surgery have reported high success rates. The efficacy of this treatment has primarily been determined by a single electrocardiogram (ECG) or 24-h Holter monitor at follow-up. We sought to assess the true efficacy of this procedure using prolonged cardiac rhythm monitoring.
  
  
  METHODS
  One hundred patients with paroxysmal (n = 47) and persistent AF (n = 53) requiring cardiac surgery were enrolled. Patients were clinically reviewed 6 weeks post-operatively and were monitored with 7-day Holter with full disclosure, 6 months post-surgery. A cohort of 50 patients also underwent 7 day Holter monitoring preoperatively. AF recurrence was defined as >30 s of AF.
  
  
  RESULTS
  At 6 months, 75% of patients were in sinus rhythm according to a single ECG. However, only 62% of patients were free from AF on 7-day Holter; all AF episodes in these patients were asymptomatic. The procedure resulted in a significant decrease in AF burden from 56.2% at baseline to 27.5% at 6 months follow-up, (p < 0.001). Predictors of AF recurrence were (1) pre-operative AF duration; (2) persistent compared with paroxysmal AF; (3) increasing left atrial diameter and (4) requirement for mitral valve surgery.
  
  
  CONCLUSIONS
  Surgical RFA for the treatment of AF, during concomitant cardiac surgery, is a successful procedure and significantly reduces AF burden. However, 13% of patients have asymptomatic AF episodes only identified with continuous monitoring. This has important implications for post-operative anti-arrhythmic and anticoagulant management and for the definition of surgical AF ablation success.
authors.affiliation: Department of Cardiology, East Sussex Hospitals NHS Trust, Eastbourne, UK. raveasey@doctors.org.uk
authors.forename: Rick A
authors.initials: RA
authors.lastname: Veasey
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Segal
authors.forename: Janet K
authors.initials: JK
authors.lastname: Large
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lewis
authors.forename: Uday H
authors.initials: UH
authors.lastname: Trivedi
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Cohen
authors.forename: Jonathan A J
authors.initials: JA
authors.lastname: Hyde
authors.forename: A Neil
authors.initials: AN
authors.lastname: Sulke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D015897:Comorbidity; D015716:Electrocardiography, Ambulatory; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D016896:Treatment Outcome