Key result
Continuous subcutaneous ECG monitoring detected atrial fibrillation recurrences in 66.3% of post-ablation patients, compared to 35.4% detected by symptoms and scheduled ECGs.
Why the study?
What is the true incidence of asymptomatic and symptomatic atrial fibrillation recurrences detected by continuous subcutaneous ECG monitoring following transcatheter ablation?
Cohort (n=113)
What is the true incidence of asymptomatic and symptomatic atrial fibrillation recurrences detected by continuous subcutaneous ECG monitoring following transcatheter ablation?
Continuous ECG monitoring reveals that up to half of patients experience asymptomatic AF recurrences after ablation, indicating that symptom-based and scheduled ECG follow-up significantly underestimates true recurrence rates.
Answers are grounded in this paper and cite their sources.
Symptom-based follow-up underestimates post-ablation AF recurrences; leaves open whether continuous monitoring alters management or outcomes.
BACKGROUND: Atrial fibrillation (AF) relapses, following transcatheter AF ablation, are frequently reported based on patients' symptoms, scheduled electrocardiograms (ECGs), or 24-hour Holter recordings. The aim of this study is to determine the incidence of asymptomatic and symptomatic AF recurrences, using continuous subcutaneous ECG monitoring, in the long-term follow-up of patients with paroxysmal or persistent AF undergoing transcatheter ablation. METHODS AND RESULTS: In total 113 consecutive patients symptomatic for paroxysmal or persistent AF were enrolled. All patients underwent pulmonary vein isolation plus left linear lesions. The insertable cardiac monitor (ICM), subcutaneously implanted during the ablation procedure, recorded the amount of AF per day (daily burden) and per last follow-up period (total AF burden). Based on symptoms and on scheduled 12-lead ECG performed during follow-up, 40 patients (35.4%) suffered AF recurrences. By means of ICM data, however, arrhythmia relapses were recorded within 75 patients (66.3%), of whom 35 (46.7%) were asymptomatic. Patients suffering symptomatic AF recurrences resulted, at univariate analysis, older (66.6 ± 8.4 years vs 61.6 ± 10.7 years) and suffering greater AF burden (88.8 ± 26.9% vs 8.0 ± 8.0%). CONCLUSIONS: AF ablation outcome based on patients' symptoms and/or scheduled ECGs underestimated relapses, as up to half of the patients, during a long-term follow-up, suffer asymptomatic recurrences.
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Manganiello et al. (2014) conducted a cohort in Paroxysmal or persistent atrial fibrillation (n=113). Continuous subcutaneous ECG monitoring (ICM) vs. Symptoms and scheduled 12-lead ECG was evaluated on Atrial fibrillation recurrences. Continuous subcutaneous ECG monitoring detected atrial fibrillation recurrences in 66.3% of post-ablation patients, compared to 35.4% detected by symptoms and scheduled ECGs.
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