Introduction: Surgical atrial fibrillation (AF) therapy is gaining widespread acceptance among cardiothoracic surgeons. However, assessment of therapy success is until now solely based on short time -“snapshot”-rhythm surveillance often at irregular time intervals. In order to evaluate the ablation’s success we intraindividually compared two different types of follow-up strategies: conventional 24h-Holter monitoring and direct long time rhythm surveillance achieved by a new implantable monitor device (IRMD).
Methods: 20 cardiac surgical patients (male 16, mean age 69±9y) with a mean AF of 30±48m (paroxysmal n=7, persistent n=9, long standing persistent n=4) were treated intraoperatively with epicardial high intensity focus ultrasound (HIFU) ablation (+CABG n=10, +AVR n=5, +AVR/CABG n=2, +valve preserving ascending aorta replacement n=2, +endoaneurymoraphy n=1, lone atrial fibrillation n=1). Postoperative heart rhythm monitoring was accomplished in all patients with a 24h-Holter-monitor at prescheduled time intervals and additionally with a new implantable monitor device (Reveal XT, Medtronic®, MN, USA). A more than 0.5% of “time in AF” as reported by the IRMD was considered as recurrence of AF. Telemetry of the IRMD was performed simultaneously after completion of 24h-Holter monitoring.
Results: During a mean FU of 8.7±1.4m a total of 29 24 h-Holter-monitors were obtained. Sinus rhythm was documented in 21, the IMRD however revealed AF recurrence in 11 of these cases. Thus, conventional 24 h ECG monitoring failed to identify AF recurrence in 59% of cases (p<0.027). Success rate after surgical ablation therapy (defined as freedom from AF recurrence of more than 0.5% of observational period) was 72% with 24h Holter monitoring, but only 35% using continuous ECG monitoring with IRMD.
Conclusion: In order to evaluate better “real life” outcomes after atrial fibrillation ablation therapy, long term continuous heart rhythm surveillance instead of -“snapshot” - heart rhythm monitoring is mandatory. This is particularly important for the decision to alter medical therapies, e.g. oral anticoagulation or antiarrhythmic treatment.
Minimal or No Touch Electrocardiography Recording and Remote Heart Rhythm Monitoring during COVID-19 Pandemic Era