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(Circulation. 2009;120:S177-S184.)
© 2009 American Heart Association, Inc.

Arrhythmia Surgery

Twenty-Four–Hour Holter Monitor Follow-Up Does Not Provide Accurate Heart Rhythm Status After Surgical Atrial Fibrillation Ablation Therapy

Up to 12 Months Experience With a Novel Permanently Implantable Heart Rhythm Monitor Device

Thorsten Hanke, MD; Efstratios I. Charitos, MD; Ulrich Stierle, MD; Antje Karluss, MD; Ernst Kraatz, MD; Bernhard Graf, MD; Axel Hagemann, MD; Martin Misfeld, MD, PhD; Hans H. Sievers, MD

From the Department of Cardiac and Thoracic Vascular Surgery (T.H., E.I.C., U.S., A.K., E.K., M.M., H.H.S.), University of Lübeck, Germany; the Department for Cardiology (B.G.), Helios Kliniken, Schwerin, Germany; and Schlei Klinikum Schleswig (A.H.), Germany.

Correspondence to Prof Dr Hans-H. Sievers, University of Lübeck, Department of Cardiac and Thoracic Vascular Surgery, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail sievers{at}herzchirurgie.uni-luebeck.de

Background— Twenty-four–hour Holter monitoring (24HM) is commonly used to assess cardiac rhythm after surgical therapy of atrial fibrillation (AF). However, this "snapshot" documentation leaves a considerable diagnostic window and only stores short-time cardiac rhythm episodes. To improve accuracy of rhythm surveillance after surgical ablation therapy and to compare continuous heart rhythm surveillance versus 24HM follow-up intraindividually, we evaluated a novel implantable continuous cardiac rhythm monitoring (IMD) device (Reveal XT 9525).

Methods and Results— Forty-five cardiac surgical patients (male 37, mean age 69.7±9.2 years) with a mean preoperative AF duration of 38±45 m were treated with either left atrial epicardial high-intensity focus ultrasound ablation (n=33) or endocardial cryothermy (n=12) in case of concomitant mitral valve surgery. Rhythm control readings were derived simultaneously from 24HM and IMD at 3-month intervals with a total recording of 2021 hours for 24HM and 220 766 hours for IMD. Mean follow-up was 8.30±3.97 m (range 0 to 12 m). Mean postoperative AF burden (time period spent in AF) as indicated by IMD was 37±43%. Sinus rhythm was documented in 53 readings of 24HM, but in only 34 of these instances by the IMD in the time period before 24HM readings (64%, P<0.0001), reflecting a 24HM sensitivity of 0.60 and a negative predictive value of 0.64 for detecting AF recurrence.

Conclusion— For "real-life" cardiac rhythm documentation, continuous heart rhythm surveillance instead of any conventional 24HM follow-up strategy is necessary. This is particularly important for further judgment of ablation techniques, devices as well as anticoagulation and antiarrhythmic therapy.

Key Words: atrial fibrillation • surgical therapy • heart rhythm documentation • follow-up study

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