Catheter ablation reduced total AF burden, but the ratio of asymptomatic to symptomatic AF episodes significantly increased from 1.1 pre-ablation to 3.7 post-ablation (P=0.002).
Cohort (n=50)
Blinded adjudication
Does catheter ablation alter the incidence and ratio of symptomatic to asymptomatic atrial fibrillation episodes in patients with symptomatic AF?
Catheter ablation significantly reduces overall atrial fibrillation burden but increases the proportion of asymptomatic episodes, demonstrating that symptom-based monitoring alone underestimates post-ablation recurrence.
Absolute Event Rate: 3.7% vs 1.1%
p-value: p=0.002
BACKGROUND: The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation. METHODS: Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms. RESULTS: Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (P < .001), and 56.0% of all episodes were asymptomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P = .002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF. CONCLUSIONS: The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00745706.
Verma et al. (Mon,) conducted a cohort in Symptomatic atrial fibrillation (n=50). Catheter ablation vs. Pre-ablation state was evaluated on Ratio of asymptomatic to symptomatic AF episodes (p=0.002). Catheter ablation reduced total AF burden, but the ratio of asymptomatic to symptomatic AF episodes significantly increased from 1.1 pre-ablation to 3.7 post-ablation (P=0.002).