Defining the BURden after surgical ablation therapY for the treatment of Atrial Fibrillation

Rationale: AF recurrences after ablation therapy (surgical and catheter
ablation) are common within the first months after AF ablation. The temporarily
increased risk of recurrences may be related to atrial edema, local
inflammatory response leading to enhanced automaticity or vulnerability of the
atrial substrate to AF, increased adrenergic tone and changes in fluid and
electrolyte balance. An early recurrence of AF after ablation does not
necessarily indicate long-term ablation failure. Therefore, the definition of
1-year success was stated as freedom from AF/AFL/AT (>30 seconds) off
antiarrhythmic drug therapy as assessed from the end of the 3-month blanking
period to 12 months following the ablation procedure. This statement is based
on literature derived from experience after catheter ablation for AF. It can be
speculated that the amount of tissue necrosis after surgical ablation is higher
compared to catheter ablation. Consequently, the amount of tissue edema in and
around the lines could therefore be more extended and longer lasting.
Furthermore, (thoracoscopic) AF surgery results in some degree of
post-pericardiotomy syndrome which might be responsible for AF recurrences
itself. We hypothesize that the blanking period after (thoracoscopic) surgical
ablation might be longer than the arbitrarily chosen 3 months period after AF
ablation.
Patients suffering from AF suffer from considerable impairment in quality of
life (QoL). One of the main goals of treatment is to restore rhythm to improve
symptoms, and to improve quality of life. The current definition of success
according to the 2014 HRS statement defines a single recurrent episode of
AT/AF/AFl of more than 30 seconds 3 months after ablation as failure while the
actual burden and possibly also the quality of life could potentially have been
improved significantly.

The primary objective of the study is:
- to evaluate the burden of AF and quality of life rhythm after thoracoscopic
ablation surgery and after port-access concomitant left atrial MAZE surgery by
continuous rhythm monitoring (Medtronic Reveal Linq Insertable Cardiac
Monitor*).
Secondary objectives are:
- to evaluate freedom from AF/AFl/AT,
- to assess the clinical safety of the procedure
- to assess neurologic outcome (ischemic stroke, hemorrhagic stroke, transient
ischemic attack)
- to evaluate the postoperative biochemical cardio-inflammatory response
(NT-pro-BNP, CRP, IL-6 and troponin levels)

Single-center, prospective observational cohort study

There are no risks associated with participation. During hospitalization the
blood collection for this study will be performed simultaneously with routine
blood collection (2/4). Three months after surgery blood collection will be
performed one more time, simultaneously with a routine visit