Back to Annual Meeting
Objective: Historically, success of surgical treatment of atrial fibrillation (AF) has been measured by electrocardiograms (ECGs) at various intervals. However, continuous monitoring of cardiac rhythms by “autocapture” devices has recently become more available and convenient. The concordance of measurements of freedom from AF by these two techniques has not been reported after surgical ablation.
Back to Program
John Puskas1, Alexis Neill1, Patrick Kilgo2, Thomas Vassiliades1, Robert Guyton1.
1Cardiothoracic Surgery, Emory University, Atlanta, GA, USA, 2Biostatistics, Emory University, Rollins School of Public Health, Atlanta, GA, USA.
Methods: Between August 2005 and May 2006, 47 patients at a single academic center underwent surgical ablation procedures for AF, 41 of which were concomitant with other cardiac surgery and 6 of which were stand alone, non-sternotomy procedures. Each patient had a 12-lead “spot” ECG and a one-week continuous cardiac rhythm event recording at 3 months or 6 months (or both) after surgical ablation. These two measures were used to evaluate each patient’s freedom from any AF. Agreement between these diagnostic modes was measured using the kappa statistic at 3 and 6 months (kappa of 1 is perfect agreement, 0 is no agreement). McNemar’s Test was employed to determine whether agreement significantly changed from 3 to 6 months.
Results: At 3 months follow-up, spot ECGs suggested that 81% (38/47) of surgical patients were free of any AF, while one-week event recordings found only 70% (31/44) of patients were free of any AF. At 6 months, spot ECGs estimated that 87% (40/46) of surgical patients were free of AF; one-week event recordings found only 74% (34/46) of patients were free of AF. The kappa measures (with 95% CI) at 3 and 6 months were .52 (.24, .80) and .60 (.32, .87), respectively, showing only moderate agreement. McNemar’s Test showed no significant shift in agreement from 3 to 6 months (p=.2059). Overall, 81% (35/43) and 77% (33/43) of patients were on anti-arrhythmic drugs (AADs) and warfarin, respectively, at 3 months. At 6 months, 72% (31/43) remained on AADs and 56% (24/43) continued on warfarin therapy. There were no deaths or strokes, but 1 MI among these 47 patients during 6 months follow-up.
Conclusions: “Spot” ECGs underestimate the incidence of recurrent AF after surgical ablation for atrial fibrillation and show poor agreement with the more reliable one-week event recordings.
Back to Annual Meeting
Back to Program