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Background Postoperative atrial fibrillation (POAF) is common and associated with poor outcomes. Perioperative ischemia can alter arrhythmic substrate. Objective To demonstrate an association between perioperative measurements of heart-type fatty acid binding protein (HT-FABP), a sensitive marker of ischemic myocardial injury. Methods Blood samples from 63 inpatients undergoing coronary artery bypass surgery, valve surgery, or both were obtained before and up to 4 days after surgery. Continuous telemetry monitoring was used to detect POAF. Fifty-nine patients had at least 3 HT-FABP measurements. The relationship of enzyme-linked immunosorbent assay-measured HT-FABP with POAF was assessed by using joint logistic regression adjusted for age and surgery type. Results Thirty-five patients (55%) developed POAF; these were, on average, older (69.3±10 years vs 60±11 years; P = .0019), with a higher prevalence of heart failure (43% vs 17%; P = .034), chronic obstructive lung disease (26% vs 4%; P = .017), preoperative calcium channel blocker use (29% vs 7%; P = .031), and more likely to undergo combined surgery (21% vs 11%, P = .049). The joint age- and coronary artery bypass surgery-adjusted model revealed that postoperative but not preoperative HT-FABP levels predicted POAF (coefficient 1.9±0.87; P = .03). Longer bypass time, prior infarction, and worse renal function were all associated with higher postoperative HT-FABP . Conclusions A greater rise of HT-FABP is associated with atrial fibrillation after cardiac surgery, suggesting that ischemic myocardial damage is a contributing underlying mechanism. Interventions that decrease perioperative ischemic injury may also decrease the occurrence of POAF.

the American College of Cardiology Foundation Board of ssociation Science Advisory and Coordinating Committee, oard of Trustees in February 2008. iology Foundation, American Heart Association, and Heart s document be cited as follows: Epstein AE, DiMarco JP, I, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, y MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, CC/AHA/HRS 2008 guidelines for device-based therapy of report of the American College of Cardiology/American n Practice Guidelines (Writing Committee to Revise the deline Update for Implantation of Cardiac Pacemakers and oll Cardiol 2008;51:e1–62. This article h 2008 issue of H Copies: Thi College of C americanheart.o document, plea reprints@elsevie Permissions: tion of this doc College of Ca Society. Pleas elsevier.com. avid L. Hayes, MD, FACC, FAHA, FHRS* ark A. Hlatky, MD, FACC, FAHA . Kristin Newby, MD, FACC, FAHA ichard L. Page, MD, FACC, FAHA, FHRS ark H. Schoenfeld, MD, FACC, FAHA, FHRS ichael J. Silka, MD, FACC ynne Warner Stevenson, MD, FACC, FAHA‡ ichael O. Sweeney, MD, FACC*

Background Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM). Objective The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM. Methods One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included. Results After follow-up of 35 months (interquartile range 13, 60), 29% of patients who underwent catheter ablation and 51% of those who had undergone AF surgery had no documented recurrent atrial arrhythmia after a single procedure. Repeat ablation was performed in 55% of patients with recurrent arrhythmia in the catheter group and 24% in the surgery group, increasing the success rate to 39% and 53%, respectively, after 1 or more procedures. Predictors of success after the first procedure in a multivariable setting included higher baseline EF and male gender. Persistent or long-standing AF and log of AF duration were associated with lower success. Major complications occurred in 6% of the catheter ablation group and 18% of the AF surgery group. During follow-up, 16 patients died (9 in catheter group, 7 in surgery group) and 1 underwent heart replacement. Lower baseline EF and older age were independently associated with death. Conclusion Catheter ablation and AF surgery are associated with symptomatic improvement in HCM patients. However, long-term success is lower and complications are higher than previously reported.

torso model was used to compute surface ECGs and electrograms over the entire atria. Dominant frequencies (DF) were extracted from each of the signals. Results: During simulated AF with multiple wavelets (no focal activity) and cycle lengths in the range 140-240 ms (median 153 ms), the DFs of the atrial electrograms mainly clustered around 4.3 and 6.7 Hz, corresponding to regions having longer or shorter APDs, respectively. The computed ECGs showed many of the features of clinical ECGs (see Fig.). The DFs of leads V1 and V2 were 5.3 and 6.7 Hz respectively. Leads V3-V6, however, were characterized by two DFs at 4.0 and 6.7 Hz, the former peak being more pronounced in V6 than in V3. These values lay within the clinical range of 5.6 1.1 Hz (min 3.1, max 8.1 Hz) measured in 31 patients with AF (lead V1 after QRST cancellation). Conclusion: The results suggest that standard EGCs carry information about the DFs of AF. Computer models may help select the most valuable features of ECG signals and lead positions to facilitate the evaluation of the underlying AF dynamics.