title: Concomitant surgical atrial fibrillation ablation and event recorder implantation: better monitoring, better outcome?
abstract: OBJECTIVE
  Concomitant ablation is an established therapy in cardiac surgical patients with atrial fibrillation (AF). Post-discharge care seems to be an essential factor for clinical outcome. We analysed the influence of event recorder (ER) implantation and therapy guidance by the results of continuous rhythm monitoring of consecutive postoperative follow-up by our department of electrophysiology.
  
  
  METHODS
  Between July 2003 and August 2010, 401 cardiac surgical patients underwent concomitant surgical AF ablation therapy. Since August 2009, an ER (REVEAL XT, Medtronic, Inc., Minneapolis, MN, USA) was implanted in 98 patients intraoperatively. ER interrogation was performed by our department of electrophysiology 3, 6 and 12 months postoperatively. Results and outcomes were compared with a matched cohort of patients with ablation and no ER implantation. In those patients, rhythm follow-up was obtained by 24-h Holter ECG. Primary end-point of the study was sinus rhythm rate after 12 months.
  
  
  RESULTS
  Mean patient's age was 67.0 ± 9.7 years, and 68.4% were male. No major ablation-related complications occurred. The overall sinus rhythm rate was 65.3% after 1-year follow-up. The sinus rhythm rate off antiarrhythmic drugs was 60.3%. The conversion rate tended to be higher in patients with an implanted ER (69.3 vs 60.1%, respectively; P = 0.098). Also, the sinus rhythm rate of anti-arrhythmic drugs was higher in the ER group (64.3 vs 56.2). Patients with ER were seen more often by a cardiologist in the first postoperative year (3.1 ± 0.8 vs 1.5 ± 0.9; P < 0.05) and received significantly more additional procedures, like electrical cardioversion or additional catheter-based ablation (16.1 vs 4.3%; P < 0.001; 11.2 vs 3.1%; P < 0.001).
  
  
  CONCLUSIONS
  Implantation of an ER with link-up to a cardiology and/or electrophysiology provides optimized anti-arrhythmic drug management and higher rates of consecutive procedures like cardioversion or additional catheter-based ablation. As a result, a trend to higher sinus rhythm conversion rate was observed after 1-year follow-up.
authors: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany. s.pecha@uke.de
authors: Simon
authors: S
authors: Pecha
authors: Timm
authors: T
authors: Schäfer
authors: Friederike
authors: F
authors: Hartel
authors: Teymour
authors: T
authors: Ahmadzade
authors: Irina
authors: I
authors: Subbotina
authors: Hermann
authors: H
authors: Reichenspurner
authors: Florian Matthias
authors: FM
authors: Wagner
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D013686:Telemetry / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents