Effect of a routine evaluation using an external loop recorder on the development of cardiovascular events after ablation in patients with atrial fibrillation

BACKGROUND The use of an external loop recorder (ELR) has been introduced in the assessment of atrial fibrillation (AF) recurrences after ablation. OBJECTIVES This study explored the prognostic impact of routine ELR assessments after ablation in patients with paroxysmal AF. METHODS A retrospective cohort study of consecutive patients with paroxysmal AF who underwent their first AF ablation was conducted. Patients were routinely evaluated with ELRs 6 months after the ablation from January 2015 to May 2018. Thereafter, the application of ELRs was discontinued due to clinical overload. According to the era in which the ELRs were routinely used, the participants were divided into two groups. We compared the 2-year incidence of the composite outcome of major adverse cardiovascular events (MACE), which included thromboembolisms, heart failure-related hospitalization, acute coronary syndrome, major bleeding, and cardiovascular-related death, between the ELR and non-ELR era groups. RESULTS The ELR era group included 407 patients and non-ELR era group 305. The baseline characteristics were similar between the groups. The ELR era group had a significantly lower cumulative incidence of MACE than the non-ELR era group (3.3% vs. 6.6%, log-rank, p = 0.033). The ELR was found to be an independent predictor of MACE (adjusted hazard ratio: 0.46, 95% confidence interval: 0.22-0.97, p = 0.042). CONCLUSIONS Routine evaluations of AF recurrence using an ELR 6 months after ablation were associated with a lower 2-year incidence of MACE in patients with paroxysmal AF.