Abstract 19286: Rhythm Results Following Surgical Ablation- How Should it Be Reported?
Background: The improved understanding of the pathophysiology of atrial fibrillation (AF) and the non-pharmacological approaches to treat AF provided higher success. There is a lack of uniformity and agreement in the best way to report rhythm outcomes. The study purpose is to explore the impact of longitudinal follow up on understanding the ongoing atrial arrhythmia burden compared with the static time points recommended by the Heart Rhythm Society (HRS) guidelines
Methods: All patients undergoing AF surgical ablation at our institution (n=690) are followed prospectively thru our AF registry. Rhythm verified by EKG and 24 hour holter. Patients selected for this study had to be at risk for failure at least 2 years following the procedure (n=464). The HRS definition of failure determined rhythm. Rhythm is reported per HRS guidelines/ “longitudinal rate (LR)” defined as the need for additional interventions to keep patients in SR (ablations and cardioversions).
Results: Per HRS guidelines, patients in SR at discharge was 388/464 (84%) ; 6 months 359/400 (90%) with 281/370 (76%) off antiarrhythmic drugs (AAD) ; 12 months 356/397 (90%) with 312/386 (81%) off AAD, 24 months 268/307 (87%) with 231/301 (77%) off AAD. Success per LR at 6 months 315/400 (79%), 12 months 299/397 (75%) patients and 24 months 217/301 (71%). The freedom from AF and interventions was lower at each period compared to the HRS rate. Of the patients off AAD, 12% (n=26) required an intervention suggesting that only pharmacological methods were required to maintain SR not captured per LR (Figure).
Conclusion: Surgical ablation for AF results in acceptable rhythm outcomes over time. Reporting of rhythm status only at static time points does not provide the continuous burden of atrial arrhythmia and need for follow-up pharmacological and non-pharmacological interventions. We recommend patients should be followed using the two methodologies to improve understanding of the rhythm results following ablation for AF.
- © 2012 by American Heart Association, Inc.