Key result
Post-ablation implantable monitors reach ~86% positive predictive value for AF with longer detection thresholds.
Observational (n=419)
Continuous monitoring using an implantable cardiac monitor after AF ablation demonstrates that varying detection durations and assessment methods significantly impact reported success rates, suggesting >6 min duration and >0.1% burden as standardized definitions for future studies.
Longer ICM detection durations raise PPV for post-ablation AF; supports standardizing ≥6 min episodes in trials without changing practice.
Aims: To study device performance, arrhythmia recurrence characteristics, and methods of outcome assessment using a novel implantable cardiac monitor (ICM) in patients undergoing ablation for atrial fibrillation (AF). Methods and results: In 419 consecutive patients undergoing first-time catheter ablation for symptomatic paroxysmal (n = 224) or persistent (n = 195) AF an ICM was injected at the end of the procedure. Telemedicine staff ensured full episode transmission coverage and manually evaluated all automatic arrhythmia episodes. Device detection metrics were calculated for ≥2, ≥6, and ≥10 min AF detection durations. Four methods of outcome assessment were studied: continuous recurrence analysis, discontinuous recurrence analysis, AF-burden analysis, and analysis of individual rhythm profiles. A total of 43 673 automatic AF episodes were transmitted over a follow-up of 15 ± 6 months. Episode-based positive predictive values changed significantly with longer AF detection durations (70.5% for ≥2 min, 81.8% for ≥6 min, and 85.9% for ≥10 min). Patients with exclusive short episode recurrences (≥2 to <6 min) were rare and their arrhythmia detection was clinically irrelevant. Different methods of outcome assessment showed a large variation (46-79%) in ablation success. Individual rhythm characteristics and subclinical AF added to this inconsistency. Analysis of AF-burden and individual rhythm profiles were least influenced and showed successful treatment in 60-70% of the patients. Conclusion: We suggest AF detection duration >6 min and AF burden >0.1% as a standardized outcome definition for AF studies to come in the future.
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Wechselberger et al. (2018) conducted an observational in Atrial fibrillation (n=419). Implantable cardiac monitor (ICM) was evaluated on Device performance (positive predictive value) and ablation success across different outcome assessment methods. Implantable cardiac monitors after AF ablation yielded positive predictive values for AF detection that improved with longer durations, from 70.5% for ≥2 minutes to 85.9% for ≥10 minutes.
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