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The Implementation of a Comprehensive Clinical Protocol Improves Long Term Success Following Surgical Treatment of Atrial Fibrillation
Niv Ad, Linda Henry, Sharon Hunt, Lori Stone
Inova Heart and Vascular Institute, Falls Church, VA
BACKGROUND:Unlike the clear definitions for the surgical procedure to treat atrial fibrillation, no guidelines or definitions regarding perioperative and postoperative treatment exist. More commonly, patients are often being followed by their cardiologists who are unfamiliar with the nuances of the surgical procedure as well as the management of patients’ medical regimen and recurrence of post surgery arrhythmia. We sought to determine the effectiveness of a post discharge protocol designed to coordinate patient management between the cardiac surgeon and cardiologist.
METHODS:Our atrial fibrillation surgery center captures all patients having the maze procedure into a registry designed to provide longitudinal comprehensive clinical follow ups at 3, 6, 9,12,18, 24 months. The prospective follow up information collected includes: rhythm status, medications and interventions. Letters with the post discharge protocol as well as letters recommending further interventions required to comply with the protocol were sent to the cardiologists, at the follow up time points
RESULTS:Currently, we have 334 patients (multiple surgeons) in our registry with over 1600 records and follow up rhythm status information. Independent of the clinical protocol, the return to SR was 86%, 84%, 84% and 84% at 6, 12, 24 and last follow up respectively (mean time to FU=25.1 months). Significantly improved results were documented for patients who were treated according to the protocol with SR rate of 90% vs 81%, 88% vs 76%, 90% vs 65% and 89% vs 79% at 6, 12, 24 and last follow up respectively (Figure 1). Failure to complete the protocol was documented in 38% of the patients in AF, with the most common deviations being anti-arrhythmic drug treatment, any attempt of cardioversion and placement of patients on rate control regimen prematurely.
CONCLUSIONS:The success rate of the maze procedure is significantly better in patients that were treated according to the clinical protocol. Clinical coordination with the cardiologist is challenging but important; therefore, centers performing the surgical treatment for AF should make the effort to implement a comprehensive clinical algorithm to improve the outcome following the maze procedure. 
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