DURATION OF ATRIAL FIBRILLATION WITHIN FIRST THREE MONTHS AFTER SURGICAL TREATMENT AS A PREDICTOR OF LATE EFFECTIVENESS OF RADIOFREQUENCY ABLATION: DATA OF CONTINUOUS HEART RATE MONITORING

To assess the atrial fibrillation (AF) burden using insertable cardiac monitors within first months of post-operation period and reveal its correlation with the late recurrence of arrhythmia, 642 patients (478 men) aged 56±7.6 years with symptomatic AF resistant to antiarrhythmic therapy were included into the retrospective study. Radiofrequency isolation of the right and left pulmonary veins (IPV) was performed by separate collectors using irrigated electrodes. The entrance and exit block was confirmed during pacing or with the aid of Lasso catheter. The Reveal XT device (Medtronic) was implanted between ribs III and IV parallel to the sternum, 1 cm from its edge. Patients with the AF burden of <0.5% according to the implantable recorder data were considered responders; and patients with AF burden of >0.5% were considered non-responders. After the first ablation procedure, by the end of 12 month follow-up, 417 patients of 642 (65%) were responders. In accordance with the ROC curve data, the patients with absence and presence of AF recurrence were separated based on the AF burden recorded by implantable recorders (devices) within 2 months following ablation. The curse showed 85% of specificity and 90% of sensitivity. The corresponding AF burden threshold according to the implantable recorder data obtained within 2 months following ablation which permitted one to identify patients with a risk of late recurrence of AF was 4.5%. It corresponded to the overall duration of AF of 65.9 hours (2.75 days). The positive and negative diagnostic value was 78.7% and 93.9%, respectively. The majority of patients with the AF burden >4.5% had also prolonged episodes of arrhythmia exceeding 20 hours/day within two consecutive days during two first months of post-operation period. In the group of patients with persistent AF, the AF burden equal to 4.5% showed 91% of specificity corresponding to the 100% sensitivity. All patients with persistent AF and the AF burden <4.5% were responders (p<0.001). Thus, the AF burden obtained according to the implantable recorder data within the “blind” period, can predict the late effectiveness of surgical treatment. The AF burden of >4.5% within the first two months after the operation can be used for selecting appropriate candidates for repetitive operation and medical treatment.

atrial fibrillation, insertable cardiac monitor, ostial pulmonary vein isolation, post-operation period, antiarrhythmic therapy

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