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Published in: Heart and Vessels 8/2016

01-08-2016 | Original Article

Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients

Authors: Simon Pecha, Muhammet Ali Aydin, Teymour Ahmadzade, Friederike Hartel, Boris Hoffmann, Daniel Steven, Stephan Willems, Hermann Reichenspurner, Florian Mathias Wagner

Published in: Heart and Vessels | Issue 8/2016

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Abstract

Different follow-up methods have been used to report success rates after AF ablation. Recent studies have shown that intermittent rhythm monitoring underestimates the actual AF recurrence rate. We therefore report our experience with continuous rhythm monitoring by implantable loop recorder (ILR) in a large patient cohort. Between 09/2008 and 12/2012, 343 cardiac surgical patients underwent concomitant surgical AF ablation. ILR implantation was performed in 206 patients. ILR interrogation was accomplished at 3, 6 and 12 months postoperatively. Successful ablation was defined as AF Burden <0.5 %. Primary outcome of the study was freedom from AF at 12-month follow-up. Mean patient’s age was 70.5 ± 7.4 years. No major ablation- or ILR-related complications occurred. In 4 patients (1.9 %) ILR had to be explanted due to ILR-related wound infection (n = 2) or chronic pain (n = 2). Survival rate at 1-year follow-up was 96.6 %. Freedom from AF rate after 1-year follow-up was 68.5 and 63.6 % off antiarrhythmic drugs, respectively. Statistically significant predictors for successful ablation at 1-year follow-up were smaller LA diameter, shorter duration of AF and preoperative paroxysmal AF. Demographic data, indication for surgery, lesion set and used energy source had no impact on freedom from AF after 1 year. Continuous ILR monitoring after concomitant surgical AF ablation was safe and feasible, with registered freedom from AF rate of 68.5 % at 1-year follow-up. Thus continuous rhythm monitoring provides reliable outcome data and helps to guide antiarrhythmic therapy.
Literature
1.
go back to reference Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486CrossRefPubMed Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486CrossRefPubMed
2.
go back to reference Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, Safford R, Mickel M, Barrell P, Investigators AFFIRM (2005) Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 149(4):657–663CrossRefPubMed Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, Safford R, Mickel M, Barrell P, Investigators AFFIRM (2005) Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 149(4):657–663CrossRefPubMed
3.
go back to reference Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Smith SC Jr, Priori SG, Estes NA 3rd, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson WG, Tarkington LG, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123(10):e269–e367CrossRefPubMed Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Smith SC Jr, Priori SG, Estes NA 3rd, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson WG, Tarkington LG, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123(10):e269–e367CrossRefPubMed
4.
go back to reference Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 9:632–696CrossRefPubMed Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 9:632–696CrossRefPubMed
5.
go back to reference Hanke T, Charitos EI, Stierle U, Karluss A, Kraatz E, Graf B, Hagemann A, Misfeld M, Sievers HH (2009) Twenty-four-hour Holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 120(11 Suppl):S177–S184CrossRefPubMed Hanke T, Charitos EI, Stierle U, Karluss A, Kraatz E, Graf B, Hagemann A, Misfeld M, Sievers HH (2009) Twenty-four-hour Holter monitor follow-up does not provide accurate heart rhythm status after surgical atrial fibrillation ablation therapy: up to 12 months experience with a novel permanently implantable heart rhythm monitor device. Circulation 120(11 Suppl):S177–S184CrossRefPubMed
6.
go back to reference Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD (2005) Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm 2(2):125–131CrossRefPubMed Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD (2005) Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm 2(2):125–131CrossRefPubMed
7.
go back to reference Charitos EI, Stierle U, Ziegler PD, Baldewig M, Robinson DR, Sievers HH, Hanke T (2012) A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions. Circulation 126(7):806–814CrossRefPubMed Charitos EI, Stierle U, Ziegler PD, Baldewig M, Robinson DR, Sievers HH, Hanke T (2012) A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions. Circulation 126(7):806–814CrossRefPubMed
8.
go back to reference Hindricks G, Pokushalov E, Urban L, Taborsky M, Kuck KH, Lebedev D, Rieger G, Pürerfellner H, Trial Investigators XPECT (2010) Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation: results of the XPECT trial. Circ Arrhythm Electrophysiol 3(2):141–147CrossRefPubMed Hindricks G, Pokushalov E, Urban L, Taborsky M, Kuck KH, Lebedev D, Rieger G, Pürerfellner H, Trial Investigators XPECT (2010) Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation: results of the XPECT trial. Circ Arrhythm Electrophysiol 3(2):141–147CrossRefPubMed
9.
go back to reference Kalavrouziotis D, Buth KJ, Vyas T, Ali IS (2009) Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg 36(2):293–299CrossRefPubMed Kalavrouziotis D, Buth KJ, Vyas T, Ali IS (2009) Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg 36(2):293–299CrossRefPubMed
10.
go back to reference Quader MA, McCarthy PM, Gillinov AM, Alster JM, Cosgrove DM 3rd, Lytle BW, Blackstone EH (2004) Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Ann Thorac Surg 77(5):1514–1522CrossRefPubMed Quader MA, McCarthy PM, Gillinov AM, Alster JM, Cosgrove DM 3rd, Lytle BW, Blackstone EH (2004) Does preoperative atrial fibrillation reduce survival after coronary artery bypass grafting? Ann Thorac Surg 77(5):1514–1522CrossRefPubMed
11.
go back to reference Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2010) Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 121(7):948–954CrossRefPubMed Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2010) Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 121(7):948–954CrossRefPubMed
12.
go back to reference Barnett SD, Ad N (2006) Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg 131(5):1029–1035CrossRefPubMed Barnett SD, Ad N (2006) Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg 131(5):1029–1035CrossRefPubMed
13.
go back to reference Schuetz A, Schulze CJ, Sarvanakis KK, Mair H, Plazer H, Kilger E, Reichart B, Wildhirt SM (2003) Surgical treatment of permanent atrial fibrillation using microwave energy ablation: a prospective randomized clinical trial. Eur J Cardiothorac Surg 24(4):475–480CrossRefPubMed Schuetz A, Schulze CJ, Sarvanakis KK, Mair H, Plazer H, Kilger E, Reichart B, Wildhirt SM (2003) Surgical treatment of permanent atrial fibrillation using microwave energy ablation: a prospective randomized clinical trial. Eur J Cardiothorac Surg 24(4):475–480CrossRefPubMed
14.
go back to reference Abreu Filho CA, Lisboa LA, Dallan LA, Spina GS, Grinberg M, Scanavacca M, Sosa EA, Ramires JA, Oliveira SA (2005) Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation 112(9 Suppl):I20–I25PubMed Abreu Filho CA, Lisboa LA, Dallan LA, Spina GS, Grinberg M, Scanavacca M, Sosa EA, Ramires JA, Oliveira SA (2005) Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation 112(9 Suppl):I20–I25PubMed
15.
go back to reference Worku B, Pak SW, Cheema F, Russo M, Housman B, Van Patten D, Harris J, Argenziano M (2011) Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation. Ann Thorac Surg 92(6):2085–2089CrossRefPubMed Worku B, Pak SW, Cheema F, Russo M, Housman B, Van Patten D, Harris J, Argenziano M (2011) Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation. Ann Thorac Surg 92(6):2085–2089CrossRefPubMed
16.
go back to reference Deneke T, Khargi K, Grewe PH, Laczkovics A, De Dryander S, Lawo T, Müller KM, Lemke B (2002) Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J 23(2):558–566CrossRefPubMed Deneke T, Khargi K, Grewe PH, Laczkovics A, De Dryander S, Lawo T, Müller KM, Lemke B (2002) Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J 23(2):558–566CrossRefPubMed
17.
go back to reference Doukas G, Samani NJ, Alexiou C, Oc M, Chin DT, Stafford PG, Ng LL, Spyt TJ (2005) Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA 294(18):2323–2329CrossRefPubMed Doukas G, Samani NJ, Alexiou C, Oc M, Chin DT, Stafford PG, Ng LL, Spyt TJ (2005) Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA 294(18):2323–2329CrossRefPubMed
18.
go back to reference Blomström-Lundqvist C, Johansson B, Berglin E, Nilsson L, Jensen SM, Thelin S, Holmgren A, Edvardsson N, Källner G, Blomström P (2007) A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J 28(23):2902–2908CrossRefPubMed Blomström-Lundqvist C, Johansson B, Berglin E, Nilsson L, Jensen SM, Thelin S, Holmgren A, Edvardsson N, Källner G, Blomström P (2007) A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J 28(23):2902–2908CrossRefPubMed
19.
go back to reference Jiang Z, Yin H, He Y, Ma N, Tang M, Liu H, Ding F, Mei J (2014) Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation. Heart Vessels. doi:10.1007/s00380-014-0594-4 Jiang Z, Yin H, He Y, Ma N, Tang M, Liu H, Ding F, Mei J (2014) Efficacy and safety of novel epicardial circumferential left atrial ablation with pulmonary vein isolation in sustained atrial fibrillation. Heart Vessels. doi:10.​1007/​s00380-014-0594-4
20.
go back to reference Fukuda Y, Yoshida T, Inage T, Takeuchi T, Gondo T, Takii E, Imaizumi T (2012) Long-term results of the maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels 27(1):53–57CrossRefPubMed Fukuda Y, Yoshida T, Inage T, Takeuchi T, Gondo T, Takii E, Imaizumi T (2012) Long-term results of the maze procedure on left ventricular function for persistent atrial fibrillation associated with mitral valve disease. Heart Vessels 27(1):53–57CrossRefPubMed
21.
go back to reference Ziegler PD, Koehler JL, Mehra R (2006) Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm 3(12):1445–1452CrossRefPubMed Ziegler PD, Koehler JL, Mehra R (2006) Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm 3(12):1445–1452CrossRefPubMed
22.
go back to reference Dagres N, Kottkamp H, Piorkowski C, Weis S, Arya A, Sommer P, Bode K, Gerds-Li JH, Kremastinos DT, Hindricks G (2010) Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. Int J Cardiol 139(3):305–306CrossRefPubMed Dagres N, Kottkamp H, Piorkowski C, Weis S, Arya A, Sommer P, Bode K, Gerds-Li JH, Kremastinos DT, Hindricks G (2010) Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. Int J Cardiol 139(3):305–306CrossRefPubMed
23.
go back to reference Pecha S, Hartel F, Ahmadzade T, Aydin MA, Willems S, Reichenspurner H, Wagner FM (2014) Event recorder monitoring to compare the efficacy of a left versus biatrial lesion set in patients undergoing concomitant surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg 148(5):2161–2166CrossRefPubMed Pecha S, Hartel F, Ahmadzade T, Aydin MA, Willems S, Reichenspurner H, Wagner FM (2014) Event recorder monitoring to compare the efficacy of a left versus biatrial lesion set in patients undergoing concomitant surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg 148(5):2161–2166CrossRefPubMed
Metadata
Title
Implantable loop recorder monitoring after concomitant surgical ablation for atrial fibrillation (AF): insights from more than 200 continuously monitored patients
Authors
Simon Pecha
Muhammet Ali Aydin
Teymour Ahmadzade
Friederike Hartel
Boris Hoffmann
Daniel Steven
Stephan Willems
Hermann Reichenspurner
Florian Mathias Wagner
Publication date
01-08-2016
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 8/2016
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-015-0735-4

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