title: Long-term outcomes after surgical ablation for atrial fibrillation in patients with continuous heart rhythm monitoring devices.
abstract: OBJECTIVE
  Surgical ablation for atrial fibrillation (AF) is an established therapy for the treatment of concomitant AF in cardiac surgery patients. We aim to present our prospective experience with 99 continuously monitored patients and investigate whether enhanced monitoring can identify patterns and factors influencing AF recurrence after surgical AF ablation.
  
  
  METHODS
  Ninety-nine patients (73 males; age: 68.0 ± 9.2 years) with documented preoperative AF (paroxysmal: 29; persistent: 18; long-lasting persistent: 52, mean preoperative duration: 46 ± 53 months) underwent concomitant biatrial surgical ablation (Cox Maze III: 29), full set left atrial cryoablation (n = 22), high-intensity focused ultrasound (HIFU) box lesion (n = 46) or right-sided ablation (n = 2). Postoperative rhythm disclosure was provided via an implantable device. Scheduled follow-up was performed quarterly (mean ± standard deviation: 1.75 ± 1.16 years, 173.7 patient-years).
  
  
  RESULTS
  The mean postoperative AF burden during the follow-up was 7 ± 19% (median: 0.2%). Seventy-one and 82 patients had AF burden <1% and <5%, respectively. The preoperative AF duration, preoperative ejection fraction, mitral valve surgery and HIFU in patients with more persistent AF were associated with statistically significant higher postoperative AF burdens. The pattern of AF recurrence during the 3-month blanking period was associated with the amount of later AF recurrence.
  
  
  CONCLUSIONS
  Continuous rhythm disclosure reveals that very small amounts of AF burden after surgical ablation are common. The preoperative duration of AF and the use of a box lesion only in patients with longer AF persistence history were independently associated with higher postoperative AF burden recurrence. The temporal AF pattern during the blanking period after ablation should be considered for further patient management and might serve as a prognostic factor.
authors.affiliation: Department of Cardiac Surgery, University of Halle, Halle, Germany.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.affiliation: Medtronic, Inc., Minneapolis, MN, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Ziegler
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Graf
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany thorstenhanke@yahoo.com.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Arrhythmia; Atrial fibrillation; Monitoring; Surgical ablation