Ablation for atrial fibrillation during mitral valve surgery: 1-year results through continuous subcutaneous monitoring

Abstract

Continuous monitoring of cardiac rhythm may play an important role in measuring the true symptomatic/asymptomatic atrial fibrillation (AF) burden and improve the management of anti-arrhythmic and anti-thrombotic therapies. Forty-seven patients with mitral valve disease and longstanding persistent AF (LSPAF) underwent a left atrial maze procedure with bipolar radiofrequency and valve surgery. The follow-up data recorded by an implanted loop recorder were analysed after 3, 6 and 12 months. On discharge, 40 (85.1%) patients were in stable sinus rhythm, as documented by in-office electrocardiography (ECG), 4 (8.5%) were in pacemaker rhythm and 3 (6.4%) were in AF. One (2.1%) patient died after 7 months. On 12-month follow-up examination, 30 (65.2%) patients had an AF burden <0.5% and were classified as responders. Three (6.5%) of the 16 non-responders had atrial flutter and 13 (27.7%) had documented AF recurrences with an AF burden >0.5%. Two (4.3%) patients with AF recurrences were completely asymptomatic. Among the symptomatic events stored by the patients, only 27.6% was confirmed as genuine AF recurrences according to the concomitant ECG recorded by the implanted loop recorder. A concomitant bipolar maze procedure during mitral valve surgery is effective in treating AF, as proved by detailed 1-year continuous monitoring.

Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery

“…As compared with long-term monitoring, spot ECG recordings tend to overestimate success by approximately 12 percentage points. 25 A study that used continuous monitoring with an implantable loop recorder after ablation in patients with long-standing persistent atrial fibrillation showed a success rate of 65% at 1 year, 26 a finding very similar to that of our trial.…”

Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?

“…With regard to the rhythm assessment via electrocardiography (ECG) monitoring, office ECG and 24-h Holter monitoring are commonly used to assess cardiac rhythm after the ablation procedure, but they have limited abilities to detect AF paroxysmal recurrences [10,11]. Continuous and precise rhythm monitoring may help clinicians uncover the true incidence and duration of AF and assess the efficacy of different AF ablation techniques during mitral valve surgery [12,13].…”

The Role of Continuous Monitoring in Atrial Fibrillation Management

“…Ip and co-workers report that in about 45 AF patients, who underwent video-assisted epicardial ablation and ICM implantation; as many as 46 % of the AF recurrences were asymptomatic, whereas only 66 % of the symptomatic episodes were AF-related. 27 Bogachev-Prokophiev et al 28 reported ablation results for AF with mitral valve surgery after one year of continuous monitoring. If an ICM is implanted for a period before the procedure, this may help the assessment of AF behaviour and improve patient management.…”