title: Oral Anticoagulation After Successful Atrial Fibrillation Ablation Operations: Is It Necessary?
abstract: BACKGROUND
  This study analyzed the results of atrial fibrillation (AF) ablation concomitant to open heart operations using continuous monitoring.
  
  
  METHODS
  We investigated 70 consecutive patients (mean age, 72.1 ± 6 years; European System for Cardiac Operative Risk Evaluation II: 9.7% ± 8.2%) who underwent AF ablation concomitant to cardiac operations in our institution between February 2012 and February 2013. For precise rhythm analysis we implanted Reveal XT devices (Medtronic Inc, Minneapolis, MN) in all patients at the end of operations. Twenty-two patients had paroxysmal (31.4%), 20 persistent (28.6%) and 28 longstanding-persistent AF (40%). AF duration time was at a median 18 months. Cardiac rhythm data were obtained by telemonitoring at 1-month intervals, and the AF burden was calculated at 3, 6, and 9 months and at 1 year postoperatively (ablation procedure success was defined as a burden of ≤ 0.5%). Further, a neurologic follow-up was performed at 1 year postoperatively.
  
  
  RESULTS
  Overall survival was 95.7% at 30 days and 84.3% at 1 year. At 1 year, 66.7% of patients were in stable sinus rhythm, and AF burden was significantly reduced even in nonresponders: 88.2% of patients were off antiarrhythmic drugs, and oral anticoagulation had been stopped in 92.1%. No late neurologic events had occurred. Sinus rhythm at discharge and paroxysmal type of AF were predictive for later sinus rhythm (p = 0.04 and p = 0.048, respectively).
  
  
  CONCLUSIONS
  Considering the long AF duration and the high proportion of longstanding-persistent AF, the overall success of ablation procedures was satisfactory. Even though oral anticoagulation was stopped in most patients, no neurologic events were detected.
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany. Electronic address: f.schlingloff@asklepios.com.
authors.forename: Friederike
authors.initials: F
authors.lastname: Schlingloff
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Oberhoffer
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Quasdorff
authors.affiliation: ProResearch Institute, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.affiliation: Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Geidel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D061214:Patient Safety / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants