Why the study?
Patients undergoing successful cavotricuspid isthmus ablation for typical atrial flutter remain at risk for new-onset AF, but whether continuous monitoring using ILRs enhances detection compared to conventional monitoring was unknown.
Does continuous monitoring using implantable loop recorders enhance detection of new-onset atrial fibrillation in patients undergoing typical atrial flutter ablation compared to conventional monitoring?
Does continuous monitoring using implantable loop recorders enhance detection of new-onset atrial fibrillation in patients undergoing typical atrial flutter ablation compared to conventional monitoring?
Implantable loop recorders detect new-onset atrial fibrillation sooner and more frequently than conventional monitoring in patients after typical atrial flutter ablation, potentially allowing for earlier optimization of anticoagulation.
ILRs may detect new-onset AF earlier after AFL ablation than conventional monitoring; leaves open whether routine use improves outcomes.
Background Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population. Methods Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation. Results A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7–17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23–72) in the CM group ( P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation. Conclusion Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population.
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Peng et al. (2021) studied this question.
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