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DOI: 10.1055/s-0031-1297579
Concomitant surgical atrial fibrillation (AF) ablation and Event-Recorder (ER) implantation. Better monitoring – better outcome?
Aims: Concomitant ablation is an established therapy in cardiac surgical patients with AF. Post-discharge care seems to be an essential factor for clinical outcome. We analyzed the influence of ER implantation and consecutive postoperative follow up by our department of electrophysiology.
Methods: Between 07/2003 and 02/2011 402 cardiac surgical patients underwent concomitant surgical AF ablation therapy. Since 08/2009 an Eventrecorder (REVEAL XT, Medtronic) was implanted in 98 patients intraoperatively. ER interrogation was performed by our department of electrophysiology 3, 6 and 12 month postoperative. Result and outcome was compared to a matched cohort of patients with ablation and no ER monitoring. Patients were matched by type of atrial fibrillation and cardiac pathology.
Results: Mean patient's age was 67±9years, 68.4% were male. Overall sinus rhythm conversion rate was 65.3% after one year follow up. Conversion rate tended to be higher in patients with an implanted ER (69.3% vs. 60.1%, respectively; p=0.098). Patients with an ER were significantly more often seen by a cardiologist during first year post ablation (3.1±0.8 vs. 1.5±0.9p<0.05). Also additional procedures like electrical cardioversion or additional catheter based ablation were performed more often in the group with ER (16.1% vs. 4.3%; p<0.001; 11.2% vs. 3.1%; p<0.001).
Conclusion: Implantation of an Event-Recorder with link-up to a cardiology and/or electrophysiology provides optimized antiarrhythmic 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 one year.