Rhythm Control and Its Relation to Symptoms during the First Two Years after Radiofrequency Ablation for Atrial Fibrillation

• Published in: Pacing and clinical electrophysiology 2016-09, Vol.39 (9), p.914-925
• Main Authors: BJÖRKENHEIM, ANNA, BRANDES, AXEL, CHEMNITZ, ALEXANDER, MAGNUSON, ANDERS, EDVARDSSON, NILS, POÇI, DRITAN
• Format: Article
• Language: English
• Subjects: Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiac and Cardiovascular Systems; Cardiology; Catheter Ablation; Denmark; Electrocardiography, Ambulatory - methods; Female; Humans; implantable loop recorder; Kardiologi; Longitudinal Studies; Male; Middle Aged; monitoring; Reproducibility of Results; Sensitivity and Specificity; Sweden; Symptom Assessment - methods; symptoms; Treatment Outcome
• ISSN: 0147-8389; 1540-8159; 1540-8159
• DOI: 10.1111/pace.12916

Clinical Trial Registration URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359. Objectives To evaluate rhythm control up to two years after atrial fibrillation (AF) ablation and its relation to reported symptoms. Background The implantable loop recorder (ILR) continuously records the electrocardiogram (ECG), has an automatic AF detection algorithm, and has a possibility for patients to activate an ECG recording during symptoms. Methods Fifty‐seven patients (mean age 57 ± 9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18, and 24 months after ablation. Results Fifty‐four patients completed the two‐year follow‐up. Thirteen (24%) patients had no AF episodes detected by ILR during follow‐up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P < 0.001). The median AF burden in patients with AF recurrence was 5.7% (interquartile range 0.4–14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty‐eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P < 0.001). AF burden >0.5% and longest AF episode >6 hours before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring. Conclusions After AF ablation, the AF burden was low throughout the 24 months follow‐up. Nevertheless, symptoms were commonly indicated but one‐third of patient‐activated recordings did not show AF. Continuous monitoring was superior to intermittent follow‐up in detecting AF episodes and assessing the AF burden.