Comparison of two modes of long-term ECG monitoring to assess the efficacy of catheter ablation for paroxysmal atrial fibrillation

Abstract

Aims. Optimal ECG monitoring in detecting recurrences of atrial fibrillation (AF) or atrial tachycardia (AT) after catheter ablation has not been well established. The purpose of this prospective study was to compare the utility of daily ECG monitoring with episodic card recorder (ECR) vs. periodic monitoring with episodic loop recorder (ELR) for the detection of post-blanking AF/AT recurrences during early (Months 4-6) and late (Months 7-12) periods after catheter ablation for paroxysmal AF. Methods. The study included 105 consecutive patients, who received ECR for 12 months and were instructed to send at least 2 random ECG recordings daily with extra-recordings during symptoms. The patients were simultaneously monitored for one week with ELR at the end of each period (Months 6 and 12). Results. Thirty-one and 12 patients with AF/AT recurrence were identified by means of ECR and ELR, respectively. In patients with complete and valid data, ELR technology was inferior to ECR by detecting AF/AT in 5 (31%) of 16 and 5 (26%) of 19 patients with arrhythmia identified by ECR in the early and late period, respectively. Overall, ELR had a sensitivity of 8/23 (35%) for detecting AF/AT recurrence. There was no single patient with AF/AT recurrence on ELR that would not be known from ECR monitoring. Only 2 patients with arrhythmia recurrence were completely asymptomatic throughout the study period. Conclusion. Daily ECG monitoring with ECR was better than periodic monitoring with ELR in detecting AF/AT recurrences during the follow-up periods. Entirely asymptomatic patients with AF/AT recurrences were rare.

Daily ECG transmission versus serial 6-day Holter ECG for the assessment of efficacy of ablation for atrial fibrillation — the AGNES-ECG study

“…Although the total duration of TTM recordings was much shorter than that of Holter ECG monitoring in our study, diagnostic yield was higher. Similar findings have been reported by others [8]. It may be explained by the fact that some proportion of TTM recording was triggered by symptoms due to AF whereas ambulatory ECG recordings were scheduled for predefined periods.…”

“…Also in this study, frequent ECG transmissions using smartphone occurred more effective in detecting AF recurrences than standard care (61% vs 30%; p = 0.04). Also Chovancik et al [8] showed that daily ECG monitoring with episodic card recorder detected more AF recurrences after ablation than periodic 1 week monitoring with episodic loop recorder. In addition, it has been demonstrated in the STAR AF II substudy that weekly transtelephonic ECG monitoring had additive value in detecting AF episodes to standard 24-h ECG monitoring performed every 3 months after ablation [10].…”

“…Several studies documented the usefulness of this method in detecting silent AF in a high-risk population [3]; however, the value of short but frequent ECG recordings after AF ablation has not yet been established. Only a few reports dealt with this problem and showed superiority of short but frequent ECG transmissions over longer but less frequent ECG monitoring for detecting post-ablation AF recurrences [4][5][6][7][8]. The most recent 2020 AF ESC guidelines recommend post-ablation ECG monitoring using intermittent ECG, Holter ECG, patch recordings, external or implanted loop recorder, or smartphone monitor, however, do not specify which type of recording is preferred [9].…”