Document Detail

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.
MedLine Citation:
PMID:  19752365     Owner:  NLM     Status:  MEDLINE    
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. CONCLUSIONS: 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.
Thorsten Hanke; Efstratios I Charitos; Ulrich Stierle; Antje Karluss; Ernst Kraatz; Bernhard Graf; Axel Hagemann; Martin Misfeld; Hans H Sievers
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-15     Completed Date:  2009-10-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S177-84     Citation Subset:  AIM; IM    
Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Germany.
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MeSH Terms
Atrial Fibrillation / physiopathology,  surgery*
Catheter Ablation*
Electrocardiography, Ambulatory / instrumentation*
Follow-Up Studies
Heart Rate*
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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