Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey

Abstract

Atrial fibrillation (AF) is a major challenge for the healthcare field. Pulmonary vein isolation is the most effective treatment for the maintenance of sinus rhythm. However, clinical endpoints for the procedure vary significantly among studies. There is no consensus on the definition of recurrence and no clear roadmap on how to deal with recurrences after a failed ablation. The purpose of this study was to perform a survey in order to show how clinicians currently approach this knowledge gap. An online survey, supported by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, was conducted between 1 April 2022 and 8 May 2022. An anonymous questionnaire was disseminated via social media and EHRA newsletters, for clinicians to complete. This consisted of 18 multiple-choice questions regarding rhythm monitoring, definitions of a successful ablation, clinical practices after a failed AF ablation, and the continuance of anticoagulation. A total of 107 replies were collected across Europe. Most respondents (82%) perform routine monitoring for AF recurrences after ablation, with 51% of them preferring a long-term monitoring strategy. Cost was reported to have an impact on the choice of monitoring strategy. Self-screening was recommended by most (71%) of the respondents. The combination of absence of symptoms and recorded AF was the definition of success for most (83%) of the respondents. Cessation of anticoagulation after ablation was an option mostly for patients with paroxysmal AF and a low CHA2DS2-VASc score. The majority of physicians perform routine monitoring after AF ablation. For most physicians, the combination of the absence of symptoms and electrocardiographic endpoints defines a successful result after AF ablation.

Very-early symptomatic recurrence is associated with late recurrence after radiofrequency ablation of atrial fibrillation

“… 4 Different doctors still hold different views on anti-coagulation after the blanking period. 30 , 31 In addition, some studies suggest that it may be safe to discontinue anti-coagulation drugs in patients without AF recurrence. 32 , 33 Therefore, after the blanking period, it may be theoretically reasonable that patients without recurrence should consider not only the CHA 2 DS 2 -VASc score but also the LR risk score when considering the anti-coagulation strategy, which needs to be confirmed by further research.…”

Optimizing Anticoagulation Management in Atrial Fibrillation: Beyond the Guidelines. How and for Whom?

“…Cessation of anticoagulation therapy by physicians after pulmonary vein isolation has been reported in a recent European Heart Rhythm Association survey, mostly in patients with paroxysmal AF and a low CHA2DS2-VASc score. 15 However, this clinical practice cannot be supported by the current evidence and guidelines. The need to implant cardiac monitoring devices or advanced health technology, the management of mega collected data, the role of interventional therapies, the patients' compliance during possible switch on-and-off anticoagulation therapy, and cost-effectiveness are all important issues to be analyzed in-depth in the future.…”

“…score. 15 However, this clinical practice cannot be supported by the current evidence and guidelines. The need to implant cardiac monitoring devices or advanced health technology, the management of mega collected data, the role of interventional therapies, the patients' compliance during possible switch on-and-off anticoagulation therapy, and cost-effectiveness are all important issues to be analyzed in-depth in the future.…”