Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Senatore, Gaetano; Stabile, Giuseppe; Bertaglia, Emanuele; Donnici, Giovanni; Simone, Antonio De; Zoppo, Franco; Turco, Pietro; Pascotto, Pietro; Fazzari, Massimo

doi:10.1016/j.jacc.2004.11.050

Cited by 154 publications

(82 citation statements)

References 20 publications

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“…Multiple studies have demonstrated that asymptomatic AF commonly occurs in patients following catheter ablation. 56,57,63,413,442,936,937,938 Detection of these asymptomatic episodes of AF impact the characterization of the procedure as “successful.” Arrhythmia monitoring is an essential component of clinical trials aimed at assessing the outcomes of catheter ablation procedures and should be incorporated into all clinical trials designed to assess the efficacy of AF catheter ablation tools and techniques. The suggested monitoring strategies and minimum standards to be used as part of clinical trials are discussed in Section 13: Clinical Trial Design.…”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…More intensive monitoring is associated with a greater likelihood of detecting both symptomatic and asymptomatic AF. 57,414, 937,938,939,940,941,942,943,944 The proportion of asymptomatic compared with symptomatic events might be higher after AF ablation; two studies reported that the proportion of AF events that were asymptomatic was 11%–35% prior to and 53%–65% after ablation. 63,945,946 Another study reported that for patients in sinus rhythm, 53.8% of AF episodes were asymptomatic, with an increase in asymptomatic episodes changing from the acute to the chronic period after ablation, demonstrating that AF success cannot be based on the absence of symptoms alone.…”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…940,965,966 The ability to record intracardiac atrial electrograms provides excellent sensitivity and specificity for the diagnosis of atrial arrhythmias, especially with durations exceeding a few minutes. 937,967,968 …”

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

“…Basically, more intensive monitoring is associated with a greater likelihood of detecting both symptomatic and asymptomatic AF. 56,58,937 Identification of patients with AF and assessment of AF burden with intermittent monitoring have been shown to depend on a patient’s actual AF burden, and improve with an increasing frequency or duration of intermittent monitoring. Conversely, the more complex and longer the method of monitoring that is used, the lower the patient compliance.…”

Section: Section 13: Clinical Trial Designmentioning

confidence: 99%

See 3 more Smart Citations

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,760

1,468

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Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

Section: Section 8: Follow-up Considerationsmentioning

confidence: 99%

Section: Section 13: Clinical Trial Designmentioning

confidence: 99%

See 2 more Smart Citations

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,760

1,468

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“…Ablasyon sonrasında ilk 3 aylık dönemde ablate edilen dokuya bağlı ritim düzensizlikleri ve rekürrens görülebildi-ği için antiaritmik tedavi, ablate edilen dokuda sersemlemeye bağlı staz olması ve trombüs için nidus oluşması nedeniyle antikoagülan tedavi önerilmek-tedir. Bu 3 aylık periyoda kör period adı verilmiştir ve ablasyon sonrası rekürrensin bu peryottan sonra değerlendirilmesi önerilmiştir [27][28][29]. Antiaritmikler ablasyonun sebep olduğu inflamasyona bağlı proaritmik etkileri azaltıp erken AF rekürrensini engelleyebilirler.…”

Section: A-v Bloke Edici Ajanlar Ile Ventriküler Hız Kontrolüunclassified

Current approaches in atrial fibrillation treatment

Sarı¹

2014

Dicle Med J

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Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed. Key words: atrial fibrillation, rhythm, anticoagulation ÖZETAtriyal fibrilasyon (AF) klinik pratikte en sık görülen disritmi olup insidansı yaşla birlikte artış göstermektedir. Sinüs ritminini sağlayabilmeye ve oluşum süresine göre AF sınıflandırılmaktadır. Tedavi, ilk olarak hastaların ritm kontrolü veya hız kontrolü açısından uygunluğunun değerlendirilmesiyle başlar. Strateji belirlendikten sonra ikinci aşamada antikoagülan tedavinin gerekliliği araştırılır. Son zamanlarda hem ritm kontrolü hem de antikoagülan tedavide kaydedilen gelişmeler gerek Amerikan gerekse Avrupa kılavuzlarının birbiri ardına yenilenmesini gerekli kılmıştır. Bu gelişmeler yeni yayınlanan kılavuzlarda yerini almış olup bu yazıda atriyal fibrilasyon tedavisinde yaşanan bu güncel değişimler ele alınmıştır. Anahtar kelimeler: Atriyal fibrilasyon, ritim, antikoagülas-yon GİRİŞAtriyal fibrilasyon (AF) en sık görülen kardiyak ritm bozukluğu olup sıklığı yaşla birlikte artmaktadır. Gelişmiş ülkelerde prevelansı %1,5-2 olup ül-kemizde yapılan TEKHARF çalışmasındaki verilere göre pervelansı %1,25'tir [1,2]. Otonomik fokus teorisi ve multiple reentran dalga hipotezi olmak üzere iki farklı oluşum mekanizması öne sürülmüş-tür. Multiple reentran dalga hipotezinde jeneralize olarak tüm atrial dokuda iletim bozukluğu olduğu kabul edilir. Otonomik fokus teorisi ilk olarak Haissequerre ve ark. tarafından öne sürülmüş olup pulmoner ven ağızları ablasyonu ile atriyal fibrilasyonun sinus ritmine çevrildiğinin gösterilmesiyle popülerlik kazanmıştır [3].Atriyal fibrilasyon, sinus ritmine döndürüle-bilmesi ve oluşum süresine bağlı olarak sınıflandı-rılmaktadır. Genellikle ilk 48 saatte spontan olarak sinüs ritmine dönen ve 7 gün veya daha az süren formu paroksismal AF; 7 gün üzerinde süren ve kardiyoversiyonla sinüs ritmine dönebilen formuna persistan AF, 1 yılın üzerinde kardiyoversiyonla sinüs ritmine dönme ihtimali olan formuna uzun süreli persistan AF, sinus ritmine dönme ihtimalini olmayan formuna permenant (kalıcı) AF denir [4]. Avrupa kılavuzundan uyarlanan algoritma Şekil 1'de görülmektedir. Başka bir sınıflandırma ise; kalp kapak patolojilerine bağlı oluşan valvular AF (protez kalp kapağı, romatizmal mitral kapak hastalığı, tamir edilmiş mitral kapak) ve herhangi bir

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Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF)

Verma

Champagne²,

Sapp³

et al. 2013

JAMA Intern Med

276

185

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Background: The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation. Methods: Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms. Results: Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (PϽ.001), and 56.0% of all episodes were asymp-tomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P=.002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF. Conclusions: The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only.

show abstract

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Cited by 154 publications

References 20 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Current approaches in atrial fibrillation treatment

Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF)

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