Follow-up after surgical ablation therapy for atrial fibrillation (AF) using an implantable cardiac rhythm monitoring device (ICM)

Objectives: After ablation, intermittent and symptom-based monitoring of the heart rhythm may not be reliable in identifying patients with ongoing AF. For accuracy of rhythm surveillance after surgical ablation leadless ICMs were implanted.

Methods: Surgically ablation of AF was accomplished following the Cox-Maze technique modified after Damiano. Lines were produced with bipolar radiofrequency using the AtriCure® clamp. Continuity near the AV-valves was achieved applying the unipolar Isolator® Pen. In each case concomitant cardiovascular procedures were necessary. At the end of the interventions the ICMs were implanted. Amiodaron was given for six and phenprocoumon for twelve postoperative months. Patient follow-up was conducted by means of transtelephonic transmission on a monthly basis. The attending physician in private practice got access to the remote monitoring.

Results: Preoperatively, 16% of the patients had paroxysmal, 58% persistent and 26% permanent AF. Mean postoperative AF burden as indicated by ICM declined continuously over twelve months: From 49.2 to 15.8% (preoperative paroxysmal), 61.7 to 35.9% (preoperative persistent) and 70.9 to 64.5% (preoperative permanent). Atrial flutter was detected in two patients. Symptomatic bradycardia necessitated two permanent pacemakers.

Conclusion: Continuous heart rhythm monitoring with an ICM detected AF burden higher then expected. To prevent AF recurrence due to incomplete conduction block electrophysiological studies will be necessary in order to complete the ablation lines. Intensified heart rhythm follow-up and local medical networking can improve cardiac therapy.