The efficacy of intraoperative atrial radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery—the Surgical Atrial Fibrillation Suppression (SAFS) Study
Journal of interventional cardiac electrophysiology
Purpose Studies assessing radiofrequency ablation (RFA) performed at the time of concomitant cardiac surgery for the treatment of atrial fibrillation (AF) have reported high success rates. The efficacy of intraoperative RFA for AF has been primarily determined by a single electrocardiogram (ECG) or 24 hour Holter monitoring performed at pre-determined follow-up intervals. This does not discriminate between those patients in whom AF has been cured and those who continue to suffer with paroxysms
... f AF. We sought to assess the efficacy of surgical RFA by means of prolonged post-operative ambulatory monitoring. Methods 28 consecutive patients (age 74±6.3, 19 males) who had atrial RFA for AF at the time of concomitant elective cardiac surgery were assessed. Patients were reviewed at 6 weeks post-operatively and were monitored with beat to beat Holters for 7 days at 6 months post-surgery. Holters were inspected manually and AF recurrence was defined as greater than 30 beats of AF. Patients accurately documented time and duration of any symptoms and this was correlated with device Holter AF episodes. Results At 6 months post operatively and prior to 7 day Holter monitoring, 21 patients (75%) had not demonstrated any evidence of AF recurrence. On Holter analysis the mean AF burden for all patients was 32.9±47.1%, with a mean number of AF episodes per patient of 1.14±2.59. No evidence of AF recurrence was observed in 61% of patients (n=17) with 7 day monitoring. Four patients had episodes of asymptomatic paroxysmal atrial fibrillation, with a mean AF burden of 12.6% for these individuals. Conclusions Surgical RFA for the treatment of AF, performed at the time of concomitant cardiac surgery, is a highly successful procedure. However, prolonged cardiac monitoring demonstrates a significant number of patients to have asymptomatic episodes of atrial fibrillation. This has important implications for decisions regarding postoperative anti-arrhythmic and anticoagulant usage.