Use of an Implantable Monitor to Detect Arrhythmia Recurrences and Select Patients for Early Repeat Catheter Ablation for Atrial Fibrillation

Abstract

Background— Catheter ablation of atrial fibrillation (AF) has proved effective in curing highly symptomatic patients with paroxysmal AF. The aim of this prospective, randomized study was to identify the optimal treatment of patients with AF recurrences after the first ablation. Methods and Results— Two hundred eighty-six patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions) and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic). Patients without AF recurrences during the 3-month postablation period were assigned to group 1; those with AF recurrences to group 2. Patients in group 2 were randomly assigned to group 3 or group 4. Group 3 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 4 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess maintenance of sinus rhythm in each group. On 12-month follow-up examination, of the 119 (42%) patients in group 1, 112 (94%) had no AF recurrences. Among the 83 patients in group 3, only 27 (33%) had no recurrences. Of the 84 group 4 patients, 67 (80%) had no AF recurrences ( P <0.0001 versus group 3). Conclusions— Patients with recurrences after the first AF ablation are likely to respond to a second early ablation when AF is triggered by supraventricular arrhythmias or premature contractions. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01164319.

A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence

“…recently for more accurate detection of AF recurrence after ablation procedures or novel pharmacological strategies. 9 As expected, the sensitivity of these diagnostic modalities is close to 100% and, as such, is much superior to that of the currently employed 24-hour HM strategies. 8,10 However, the implantation of a CM device in all patients may seem unrealistic.…”

Premature Atrial Contractions in the General Population

“…[13][14][15][16]26,27 For example, PACs have previously been associated with an increased risk of incident AF in population based cohort studies. [13][14][15][16] Furthermore, Inoue et al found that ablation of PACs in addition to pulmonary vein isolation was associated with a high probability of recurrence-free survival among patients with persistent AF undergoing catheter ablation, suggesting that these electric triggers may play an important role in AF initiation.…”

Role of Continuous Monitoring for Optimizing Management Strategies in Patients With Early Arrhythmia Recurrences After Atrial Fibrillation Ablation

“…Consistent with these aims, Pokushalov et al, 8 in this issue of Circulation: Arrhythmia and Electrophysiology, report their observations on the use of ILR to detect ERA and select patients for early repeat catheter ablation after the initial AF ablation procedure. Their study population comprised 286 patients with paroxysmal AF.…”