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The Use of Continuous Loop Recorders in Accurately Determining the True Success of Cox-Cryomaze Procedures
Faisal H. Cheema, Muhammad A. Younus, Sophia Roberts, Muhammad J. Younus, Muhammad A. Mahmood, Harold G. Roberts, Jr..
Aegis Cardiovascular Research Foundation, Aventura, FL, USA.

OBJECTIVE: Gauging the true success of maze procedure for atrial fibrillation (AF) has been problematic largely due to the inconsistency in modalities detecting rhythm. We report our initial experience with using a continuous loop recording device for assessing true AF burden in post Cox-Cryomaze patients.
METHODS: A retrospective analysis revealed that 59 patients, who had undergone Cox-Cryomaze between Feb'2011 & Mar'2015, were implanted with a continuous loop recording device (Reveal-XT (n=41), or Reveal-LINQ (n=18), Medtronic Inc., MN) and followed up at one to three month intervals, thereafter. These Reveal devices were optimized to detect AF episodes of at least two minutes duration.
RESULTS: The mean age was 67.4±10.6 years and 54% were male. Twenty percent underwent robotic procedures. AF type included 56% paroxysmal and 44% long standing persistent. Eighty percent of patients underwent mitral surgery (MVr:83%, MVR:17%). All patients were discharged in NSR. The median time of Reveal-XT’s implantation after surgery was 26 days (Mean±SD: 43±71 days). There was no perioperative mortality. Three patients were lost to follow-up, 3 were upgraded to pacemaker and 3 had their Reveal devices removed [patient requested: 2; cardiologist recommended: 1]. The last follow-up (9.1±8.3 months [range: 0.9-38 months]) was available for 56 patients whereas 29 patients had completed their 1-year follow-up in this cohort. Freedom from AF, anti-arrhythmic drugs (AAD’s) and anti-coagulants (AC’s) was 93%, 70% and 52%, respectively at the last available follow-up (figure). Similarly, freedom from AF, AAD’s and AC’s was 90%, 76% and 76% at 1-year, respectively (figure). Over the course of the follow-up, 2 patients who first got Reveal-XT were implanted with Reveal-LINQ devices secondary to battery failures.
CONCLUSIONS: These results of the Cox-Cryomaze procedure are consistent with those reported following the traditional cut-and-sew Cox-Maze procedure and are highly effective in relieving patients of their clinically relevant AF burden. Continuous monitoring of patients undergoing surgery for AF using the Reveal-XT or Reveal-LINQ provides the ability to tailor the use of AAD’s and AC in these patients.

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