Rhythm Follow-Up
Patient follow-up was performed with a prospectively-defined schedule at
3, 6, and 12 months, and annually thereafter. At each follow-up visit,
patients underwent history and physical evaluations, as well as
electrocardiograms (ECGs). Routine prolonged monitoring was initiated in
2006 and included either 24-48 hour Holter monitoring, pacemaker
interrogation, or implantable loop recording (ILR).
91 percent of patients (146/161) underwent prolonged monitoring at some
point in their follow-up; 76% (109/143), 56% (40/73), and 60% (24/40)
of patients underwent prolonged monitoring at 1-, 5- and 7-year
follow-up, respectively. ATA recurrence was defined as any episode of
AF, atrial flutter, or atrial tachycardia lasting longer than 30
seconds, in accordance with the 2017 Heart Rhythm Society (HRS)
consensus
statement[10]. ATA
recurrence was examined in two ways. In the stricter of the two methods,
we considered any ATA recurrence that occurred greater than 3 months
postoperatively to be a permanent failure, regardless of duration of ATA
or symptoms. In our second method, we looked at the percent of patients
in SR at each time point, such that a patient who, for example, had a
recurrence at 3 years could still be recognized as being ATA-free at 5
years if they were in SR at that time. We consider this method to be
more clinically relevant given it takes into account that individual
episodes of recurrence can be short and infrequent. This allows for
differentiation between, for example, a patient who has multiple
episodes of ATA a day a patient who has had only one or two 1-minute
long episodes of ATA over their entire postoperative lifetime. Any
patient who required an interventional procedure for rhythm control
after the ninety-day blanking period was considered a treatment failure.