BACKGROUND: Although pulmonary vein isolation is an effective treatment for recurrent atrial fibrillation (AF), there is no consensus on the definition of success or follow-up strategies. Existing data are limited to intermittent Holter or transtelephonic monitoring with reliance on patient symptoms. OBJECTIVE: We sought to determine the outcomes of surgical ablation and post-ablation AF surveillance with a leadless implantable cardiac monitor (ICM). METHODS: Forty-five patients with drug-refractory paroxysmal or persistent AF underwent video-assisted epicardial ablation using a bipolar radiofrequency clamp. An ICM was implanted subcutaneously post-ablation to assess AF recurrence. AF recurrence was defined as ≥1 AF episode with a duration of ≥30 s. The device-stored data was downloaded weekly over the internet, and all transmitted events were reviewed. RESULTS: A total of 1,220 AF automatic and patient-activated AF episodes were analyzed over a follow-up of 12 ± 3 months. Of these episodes, 46% were asymptomatic. Furthermore, only 66% of the patient-activated episodes were AF. AF recurrence was highest in first 4 weeks and substantially decreased 6 months post-ablation. The overall freedom from AF recurrence at the end of follow-up was 60%. When 48-h Holter recordings were compared with the device-stored episodes, the sensitivity of the device to detect AF was 98%, and the specificity was 71%. CONCLUSIONS: The ICM provides an objective measure of AF ablation success and may be useful in making clinical decisions. This device may be used in future ablation studies to develop a more rigorous definition of procedural success.
BACKGROUND: Although pulmonary vein isolation is an effective treatment for recurrent atrial fibrillation (AF), there is no consensus on the definition of success or follow-up strategies. Existing data are limited to intermittent Holter or transtelephonic monitoring with reliance on patient symptoms. OBJECTIVE: We sought to determine the outcomes of surgical ablation and post-ablation AF surveillance with a leadless implantable cardiac monitor (ICM). METHODS: Forty-five patients with drug-refractory paroxysmal or persistent AF underwent video-assisted epicardial ablation using a bipolar radiofrequency clamp. An ICM was implanted subcutaneously post-ablation to assess AF recurrence. AF recurrence was defined as ≥1 AF episode with a duration of ≥30 s. The device-stored data was downloaded weekly over the internet, and all transmitted events were reviewed. RESULTS: A total of 1,220 AF automatic and patient-activated AF episodes were analyzed over a follow-up of 12 ± 3 months. Of these episodes, 46% were asymptomatic. Furthermore, only 66% of the patient-activated episodes were AF. AF recurrence was highest in first 4 weeks and substantially decreased 6 months post-ablation. The overall freedom from AF recurrence at the end of follow-up was 60%. When 48-h Holter recordings were compared with the device-stored episodes, the sensitivity of the device to detect AF was 98%, and the specificity was 71%. CONCLUSIONS: The ICM provides an objective measure of AF ablation success and may be useful in making clinical decisions. This device may be used in future ablation studies to develop a more rigorous definition of procedural success.
Authors: Hugh Calkins; Josep Brugada; Douglas L Packer; Riccardo Cappato; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; David E Haines; Michel Haissaguerre; Yoshito Iesaka; Warren Jackman; Pierre Jais; Hans Kottkamp; Karl Heinz Kuck; Bruce D Lindsay; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Andrea Natale; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Jeremy N Ruskin; Richard J Shemin Journal: Heart Rhythm Date: 2007-04-30 Impact factor: 6.343
Authors: Gaetano Senatore; Giuseppe Stabile; Emanuele Bertaglia; Giovanni Donnici; Antonio De Simone; Franco Zoppo; Pietro Turco; Pietro Pascotto; Massimo Fazzari Journal: J Am Coll Cardiol Date: 2005-03-15 Impact factor: 24.094
Authors: Taya V Glotzer; Emile G Daoud; D George Wyse; Daniel E Singer; Michael D Ezekowitz; Christopher Hilker; Clayton Miller; Dongfeng Qi; Paul D Ziegler Journal: Circ Arrhythm Electrophysiol Date: 2009-08-04
Authors: Daniel Steven; Thomas Rostock; Boris Lutomsky; Hanno Klemm; Helge Servatius; Imke Drewitz; Kai Friedrichs; Rodolfo Ventura; Thomas Meinertz; Stephan Willems Journal: Eur Heart J Date: 2008-02-09 Impact factor: 29.983
Authors: Ralph J Damiano; Christopher P Lawrance; Lindsey L Saint; Matthew C Henn; Laurie A Sinn; Jane Kruse; Marye J Gleva; Hersh S Maniar; Patrick M McCarthy; Richard Lee Journal: Ann Thorac Surg Date: 2015-10-24 Impact factor: 4.330