Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2014, 23(2):104-114

The impact of atrial fibrillation ablation on symptoms and arrhythmia burden: The role of pre and post-ablation continuou

Urban Ľ1, Hatala R1, Hlivák P1, De Melis M2, Garutti C2
1 Klinika kardiológie a angiológie, Národný ústav srdcových a cievnych chorôb a.s. a Lekárska fakulta Slovenskej zdravotníckej univerzity, Bratislava, Slovenská republika
2 Medtronic Bakken Research Center, Maastricht, Holandsko

Background: Symptoms and/or intermittent ECG monitoring have limited diagnostic yield for accurate atrial fibrillation (AF) detection after ablation (ABL) procedure. The aim of the single-centre pilot study was to investigate the impact of AF ABL on symptoms and AF burden (AF%), comparing pre-ABL and post-ABL clinical and ECG data collected by implantable leadless loop recorder (ILR) with AF diagnostics.

Methods and results: We prospectively enrolled 52 patients with history of symptomatic, drug refractory paroxysmal and/or persistent AF in whom ILR was implanted 3±2 months before ABL. We analyzed pre-ABL data and those at the 6 month follow-up after the 3 month post-ABL blanking period. Median AF% decreased from 19.5% (pre-ABL) to 0.4% (post-ABL, p<0.0001) and there were no further patients with persistent AF. Patients with a pre-ABL AF%<30% showed a significantly lower post-ABL AF% than patients with a pre-ABL AF%≥30% (medians=0.18% vs. 3.58%, p=0.03). Post-ABL, 34 (65%) patients were absolutely asymptomatic, while 18 (35%) still reported symptomatic episodes. Out of 18 patients with symptoms, 10 (55%) ECG stored at symptoms did not reveal any atrial arrhythmias (false positives). Out of 34 asymptomatic patients, 14 (41%) still had some AF recurrences with the post-ABL AF%≥ median of all patients (false negatives).

Conclusions: This study demonstrates a dramatic reduction in AF% and episode duration achieved through AF ABL. Poor correlation between symptoms and AF leads to misclassification of patients with or without AF recurrences. Accurate pre-ABL continuous monitoring by ILR may help to show the benefit of the procedure.

Keywords: atrial fibrillation; ablation; implantable loop recorder; symptoms

Published: February 1, 2014  Show citation

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Urban Ľ, Hatala R, Hlivák P, De Melis M, Garutti C. The impact of atrial fibrillation ablation on symptoms and arrhythmia burden: The role of pre and post-ablation continuou. Cardiology Letters. 2014;23(2):104-114.
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