Interact CardioVasc Thorac Surg 2009;9:959-960. doi:10.1510/icvts.2009.209759A
© 2009 European Association of Cardio-Thoracic Surgery
eComment: Monitoring of atrial fibrillation burden after surgical ablation
Leo Bockeria,
Amiran Sh. Revishvili and
Tamara R. Dzhordzhikiya
Bakulev Scientific Center for Cardiovasular Surgery, Roublevskoe Sh. 135, 121552 Moscow, Russia
Monitoring of atrial fibrillation burden after surgical ablation: relevancy of end-point criteria after radiofrequency ablation treatment of patients with lone atrial fibrillation
During the last decade, catheter and surgical ablation of atrial fibrillation (AF) has evolved from an experimental method to a procedure that is now commonly performed throughout the world. Recurrent AF after ablation occurs in up to 50% of patients and could be in a form of short periods of AF or persistent AF with less or without symptoms. This is of significant relevance as most of these episodes are not recognized and can lead to thromboembolic events. And evaluation of the long-term efficacy of the ablation is still one of the unresolved questions which investigators are facing.
In this article, Beukema et al. demonstrated the additional value of a new external cardiac rhythm monitoring device (AF-Alarm) in 33 patients with paroxysmal AF who underwent surgical radiofrequency ablation [1].
Studies have shown that the more intensively the patient is monitored and the longer the period of the monitoring, the greater the likelihood of detecting both symptomatic and asymptomatic AF [2]. For this reason, it is very important to find an objective method to determine AF burden. In most cases routine electrocardiogram (ECG) and 24-h Holter monitoring are the standard strategies used by investigators.
Implantable loop recorders are also available now to monitor symptomatic and asymptomatic episodes of AF and possess up to three years longevity of monitoring [3]. The first data on the Reveal® XT performance trial (XPECT) study, presented by Professor Hindricks at the Heart Rhythm Society Congress 2009, showed that Reveal® XT is not only sensitive for the detection of AF episodes, but also accurate for the measurement of AF burden and highly reliable for the exclusion of the presence of AF. The drawback is that implantable devices are rather expensive and require additional intervention. In this case continuous search of external devices providing long-term monitoring of ECG and offering optimal cost-effectiveness balance is one of the main interests of the clinicians.
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- Beukema R, Beukema W, Sie H, Misier AR, Delnoy PP, Elvan A. Monitoring of atrial fibrillation burden after surgical ablation: relevancy of end-point criteria after radiofrequency ablation treatment of patients with lone atrial fibrillation. Interact CardioVasc Thorac Surg 2009;9:956–960.[Abstract/Free Full Text]
- Vasamreddy CR, Dalal D, Dong J, Cheng A, Spragg D, Lamiy SZ, Meininger G, Henrikson CA, Marine JE, Berger R, Calkins H. Symptomatic and asymptomatic atrial fibrillation in patients undergoing radiofre-quency catheter ablation. J Cardiovasc Electrophysiol 2006;17:134–139.[CrossRef][Medline]
- Brignole M, Vardas P, Hoffman E, Huikuri H, Moya A, Ricci R, Sulke N, Wieling W. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace 2009;11:671–687.[Free Full Text]
Related Article
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Monitoring of atrial fibrillation burden after surgical ablation: relevancy of end-point criteria after radiofrequency ablation treatment of patients with lone atrial fibrillation
- Rypko Beukema, Willem P. Beukema, Hauw T. Sie, Anand Ramdat Misier, Peter Paul Delnoy, and Arif Elvan
Interactive CardioVascular and Thoracic Surgery 2009 9: 956-959.
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