Detection of atrial fibrillation after surgical ablation: Conventional versus continuous monitoring

Ralph J. Damiano*, Christopher P. Lawrance, Lindsey L. Saint, Matthew C. Henn, Laurie A. Sinn, Jane Kruse, Marye J. Gleva, Hersh S. Maniar, Patrick M. McCarthy, Richard Lee

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) after surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared with continuous monitoring using an implantable loop recorder (ILR). Methods From August 2011 to January 2014, 47 patients receiving surgical treatment for AF at 2 institutions had an ILR placed at the time of operation. Each atrial tachyarrhythmia (ATA) of 2 minutes or more was saved. Patients transmitted ILR recordings bimonthly or after any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also underwent electrocardiography (ECG) and 24-hour Holter monitoring at 3, 6, and 12 months. ILR compliance was defined as any transmission between 0 and 3 months, 3 and 6 months, or 6 and 12 months. Freedom from ATAs was calculated and compared. Results ILR compliance at 12 months was 93% compared with ECG and Holter monitoring compliance of 85% and 76%, respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11% of episodes were available for review and 46% were confirmed as AF. Freedom from ATAs was no different between continuous and intermittent monitoring at 1 year. Symptomatic events accounted for 187 episodes; however, only 10% were confirmed as AF. Conclusions ILR was equivalent at detecting ATAs when compared with Holter monitoring or ECG. However, the high rate of false-positive readings and the limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF on review.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalAnnals of Thoracic Surgery
Volume101
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Ambulatory Electrocardiography
Atrial Fibrillation
Compliance
Electrocardiography
Tachycardia
Multicenter Studies
Reading
Prospective Studies
Guidelines
Recurrence
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Damiano, R. J., Lawrance, C. P., Saint, L. L., Henn, M. C., Sinn, L. A., Kruse, J., ... Lee, R. (2016). Detection of atrial fibrillation after surgical ablation: Conventional versus continuous monitoring. Annals of Thoracic Surgery, 101(1), 42-48. https://doi.org/10.1016/j.athoracsur.2015.07.039
Damiano, Ralph J. ; Lawrance, Christopher P. ; Saint, Lindsey L. ; Henn, Matthew C. ; Sinn, Laurie A. ; Kruse, Jane ; Gleva, Marye J. ; Maniar, Hersh S. ; McCarthy, Patrick M. ; Lee, Richard. / Detection of atrial fibrillation after surgical ablation : Conventional versus continuous monitoring. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 1. pp. 42-48.
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abstract = "Background Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) after surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared with continuous monitoring using an implantable loop recorder (ILR). Methods From August 2011 to January 2014, 47 patients receiving surgical treatment for AF at 2 institutions had an ILR placed at the time of operation. Each atrial tachyarrhythmia (ATA) of 2 minutes or more was saved. Patients transmitted ILR recordings bimonthly or after any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also underwent electrocardiography (ECG) and 24-hour Holter monitoring at 3, 6, and 12 months. ILR compliance was defined as any transmission between 0 and 3 months, 3 and 6 months, or 6 and 12 months. Freedom from ATAs was calculated and compared. Results ILR compliance at 12 months was 93{\%} compared with ECG and Holter monitoring compliance of 85{\%} and 76{\%}, respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11{\%} of episodes were available for review and 46{\%} were confirmed as AF. Freedom from ATAs was no different between continuous and intermittent monitoring at 1 year. Symptomatic events accounted for 187 episodes; however, only 10{\%} were confirmed as AF. Conclusions ILR was equivalent at detecting ATAs when compared with Holter monitoring or ECG. However, the high rate of false-positive readings and the limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF on review.",
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Damiano, RJ, Lawrance, CP, Saint, LL, Henn, MC, Sinn, LA, Kruse, J, Gleva, MJ, Maniar, HS, McCarthy, PM & Lee, R 2016, 'Detection of atrial fibrillation after surgical ablation: Conventional versus continuous monitoring', Annals of Thoracic Surgery, vol. 101, no. 1, pp. 42-48. https://doi.org/10.1016/j.athoracsur.2015.07.039

Detection of atrial fibrillation after surgical ablation : Conventional versus continuous monitoring. / Damiano, Ralph J.; Lawrance, Christopher P.; Saint, Lindsey L.; Henn, Matthew C.; Sinn, Laurie A.; Kruse, Jane; Gleva, Marye J.; Maniar, Hersh S.; McCarthy, Patrick M.; Lee, Richard.

In: Annals of Thoracic Surgery, Vol. 101, No. 1, 01.01.2016, p. 42-48.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Detection of atrial fibrillation after surgical ablation

T2 - Conventional versus continuous monitoring

AU - Damiano, Ralph J.

AU - Lawrance, Christopher P.

AU - Saint, Lindsey L.

AU - Henn, Matthew C.

AU - Sinn, Laurie A.

AU - Kruse, Jane

AU - Gleva, Marye J.

AU - Maniar, Hersh S.

AU - McCarthy, Patrick M.

AU - Lee, Richard

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) after surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared with continuous monitoring using an implantable loop recorder (ILR). Methods From August 2011 to January 2014, 47 patients receiving surgical treatment for AF at 2 institutions had an ILR placed at the time of operation. Each atrial tachyarrhythmia (ATA) of 2 minutes or more was saved. Patients transmitted ILR recordings bimonthly or after any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also underwent electrocardiography (ECG) and 24-hour Holter monitoring at 3, 6, and 12 months. ILR compliance was defined as any transmission between 0 and 3 months, 3 and 6 months, or 6 and 12 months. Freedom from ATAs was calculated and compared. Results ILR compliance at 12 months was 93% compared with ECG and Holter monitoring compliance of 85% and 76%, respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11% of episodes were available for review and 46% were confirmed as AF. Freedom from ATAs was no different between continuous and intermittent monitoring at 1 year. Symptomatic events accounted for 187 episodes; however, only 10% were confirmed as AF. Conclusions ILR was equivalent at detecting ATAs when compared with Holter monitoring or ECG. However, the high rate of false-positive readings and the limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF on review.

AB - Background Current guidelines recommend at least 24-hour Holter monitoring at 6-month intervals to evaluate the recurrence of atrial fibrillation (AF) after surgical ablation. In this prospective multicenter study, conventional intermittent methods of AF monitoring were compared with continuous monitoring using an implantable loop recorder (ILR). Methods From August 2011 to January 2014, 47 patients receiving surgical treatment for AF at 2 institutions had an ILR placed at the time of operation. Each atrial tachyarrhythmia (ATA) of 2 minutes or more was saved. Patients transmitted ILR recordings bimonthly or after any symptomatic event. Up to 27 minutes of data was stored before files were overwritten. Patients also underwent electrocardiography (ECG) and 24-hour Holter monitoring at 3, 6, and 12 months. ILR compliance was defined as any transmission between 0 and 3 months, 3 and 6 months, or 6 and 12 months. Freedom from ATAs was calculated and compared. Results ILR compliance at 12 months was 93% compared with ECG and Holter monitoring compliance of 85% and 76%, respectively. ILR devices reported a total of 20,878 ATAs. Of these, 11% of episodes were available for review and 46% were confirmed as AF. Freedom from ATAs was no different between continuous and intermittent monitoring at 1 year. Symptomatic events accounted for 187 episodes; however, only 10% were confirmed as AF. Conclusions ILR was equivalent at detecting ATAs when compared with Holter monitoring or ECG. However, the high rate of false-positive readings and the limited number of events available for review present barriers to broad implementation of this form of monitoring. Very few symptomatic events were AF on review.

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