Continuous monitoring after atrial fibrillation ablation: the LINQ AF study

Abstract

AimsTo study device performance, arrhythmia recurrence characteristics, and methods of outcome assessment using a novel implantable cardiac monitor (ICM) in patients undergoing ablation for atrial fibrillation (AF).Methods and resultsIn 419 consecutive patients undergoing first-time catheter ablation for symptomatic paroxysmal (n = 224) or persistent (n = 195) AF an ICM was injected at the end of the procedure. Telemedicine staff ensured full episode transmission coverage and manually evaluated all automatic arrhythmia episodes. Device detection metrics were calculated for ≥2, ≥6, and ≥10 min AF detection durations. Four methods of outcome assessment were studied: continuous recurrence analysis, discontinuous recurrence analysis, AF-burden analysis, and analysis of individual rhythm profiles. A total of 43 673 automatic AF episodes were transmitted over a follow-up of 15 ± 6 months. Episode-based positive predictive values changed significantly with longer AF detection durations (70.5% for ≥2 min, 81.8% for ≥6 min, and 85.9% for ≥10 min). Patients with exclusive short episode recurrences (≥2 to <6 min) were rare and their arrhythmia detection was clinically irrelevant. Different methods of outcome assessment showed a large variation (46–79%) in ablation success. Individual rhythm characteristics and subclinical AF added to this inconsistency. Analysis of AF-burden and individual rhythm profiles were least influenced and showed successful treatment in 60–70% of the patients.ConclusionWe suggest AF detection duration >6 min and AF burden >0.1% as a standardized outcome definition for AF studies to come in the future.

Long‐term efficacy and safety of radiofrequency catheter ablation of atrial fibrillation in patients with cardiac implantable electronic devices and transvenous leads

“…As previously mentioned, intermittent monitoring strategies using Holter ECG recordings, for example, tend to underestimate the real AF burden after AF ablation due to a limited recording time . In addition, the assessment of outcome of AF ablation using continuous rhythm monitoring strategies has been influenced by the definition of ablation success …”

Electrophysiological findings during atrial fibrillation reablation: Extending from pulmonary vein reconnection to sequential bipolar voltage map information

“…We included consecutive patients with highly symptomatic AF who underwent consecutive index (1st) and re‐do (2nd) HD‐BVM guided AF ablations at Heart Center Dresden between January 2014 and January 2017. Patients were followed intensively with continuous monitoring as reported previously 8 …”

“…Mapping was performed as previously reported 4,8 . In brief, a HD‐BVM map (LVZ <0.5 mV) was created simultaneously with LA surface reconstruction, guided by a three‐dimensional electroanatomical mapping system (CARTO3, Biosense Webster, or Ensite Precision, Abbott) using a circular mapping catheter (Lasso, 4 mm interelectrode spacing, Biosense Webster, or Advisor FL, 3 mm interelectrode spacing, Abbott).…”

“…Additional extra PV ablation was individualized based on the voltage maps where LVZ substrates were targeted with (a) homogenization of small LVZs, (b) linear lesions connecting LVZs to anatomical obstacles (eg, PVs, or mitral annulus [MA]), and (c) linear lesions isolating large LVZs (eg, isolation of the posterior LA wall). Ablation endpoints were (a) lack of local pace capture and (b) bidirectional conduction block over linear lesions 4,5,8 …”

“…Individualized LA substrate modification (LASM) targeting LVZ in addition to pulmonary vein isolation (PVI) is an ablation strategy that tries to eliminate arrhythmogenic mechanisms harbored in such tissue areas 5,6 . Although this approach is superior against sole PVI, recurrences do occur 7,8 …”