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.