[HSF] A. Fib.

[John Pym]

Hal makes an interesting point about pacemaker interrogation being the only
truly reliable method of following post-maze AF. I wonder whether one could
justify (in the 80+% who don't need permanent pacemakers) implanting a
Medtronic Reveal subcutaneously at the time of surgery to guide further
therapy.  Even if the results are only used to limit or extend the use of
post-op amiodarone & coumadin (currently done on an arbitrary basis), this
should be cost-effective. It would certainly give gold-standard data
for comparing the results of AF ablation using the plethora of devices and
lesion sets out there. Any thoughts?

John Pym

On 7/7/07, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>
> Ajit,
> Excellent points.  Nobody wants to have their chest split to  get their AF
> cured.  The key is being able to offer a full set of lesions  via a
> minimally
> invasive approach.  I can do that.  I just submitted  an abstract to the
> STS
> that outlines my methods and results in 107  patients.  Knowing the
> politics of
> AF, I'll be surprised if it is  accepted.  What I mean by that is the
> current
> big names in AF are on the  payroll of certain device companies.  It's an
> uphill battle to get power  sources from companies who don't play the game
> published, even though they may  be the most effective in my opinion.  If
> I'm being
> oblique and murky, I  hope you can read between the lines (I'm becoming a
> little more diplomatic in my  old age.).
> Your point about the "success" rate after a surgical maze is quite  apt.
> Cox's original papers showing a 95% success rate were based on  telephone
> interviews of the patients in which they asked the patient if they  still
> had
> palpitations and an irregular heartbeat.  It is well known that  patients
> often
> lose the ability to perceive AF, presumably due to  denervation.
> My personal success rate is gauged on spot ECG's, 24 hr Holters, or  pacer
> checks.  Only the last method is truly reliable in assessing the
> AF  burden.
> Because of my interest in this field, I'm now striving getting  24hr
> Holters
> every 6 months for life.  As you know, a small, but steady  erosion in
> results
> occurs with time.
>
> Hal
>
>
>
> John Pym
> MB, BS, FRACS, FRCSC, FACS
> Professor of Surgery