Abstract
Atrial fibrillation (AF) is the most common arrhythmia prompting clinical presentation, is associated with significant morbidity and mortality. The incidence and prevalence of this arrhythmia is expected to grow significantly in the coming decades. Of the available pharmacologic and non-pharmacologic treatment options, the fastest growing and most intensely studied is catheter-based ablation therapy for AF. Given the varying success rates for AF ablation, the increasingly complex factors that need to be taken into account when deciding to proceed with ablation, as well as varying definitions of procedural success, accurate detection of arrhythmia recurrence and its burden is of significance. Detecting and monitoring AF recurrence following catheter ablation is therefore an important consideration. Multiple studies have demonstrated the close relationship between the intensity of rhythm monitoring with wearable ambulatory cardiac monitors, or implantable cardiac rhythm monitors and the detection of arrhythmia recurrence. Other studies have employed algorithms dependent on intensive monitoring and arrhythmia detection in the decision tree on whether to proceed with repeat ablation or medical therapy. In this review, we discuss these considerations, types of monitoring devices, and implications for monitoring AF recurrence following catheter ablation.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia prompting presentation for clinical care (January et al, 2014)
At 1- and 2-year follow up, other factors such as the presence of hypertension, left atrial size, left atrial appendage (LAA) emptying fraction under 20%, and decreased LAA emptying velocity were correlated with AF recurrence
This suggests that follow up monitoring and arrhythmia detection for certain patients may need to be extended past the typical 3, 6, and 12-month periods
Summary
Atrial fibrillation (AF) is the most common arrhythmia prompting presentation for clinical care (January et al, 2014). In a study tracking the burden of silent AF with continuous 7-day Holter monitoring before and serially following ablation for AF, the percentage of silent episodes of AF increased significantly at 3, 6, and 12 months following catheter ablation (Hindricks et al, 2005). At 1- and 2-year follow up, other factors such as the presence of hypertension, left atrial size, left atrial appendage (LAA) emptying fraction under 20%, and decreased LAA emptying velocity were correlated with AF recurrence This suggests that follow up monitoring and arrhythmia detection for certain patients may need to be extended past the typical 3-, 6-, and 12-month periods. Demonstrating the impact of AF ablation or lack thereof may be useful in providing objective data to patients, and reported symptoms with AF recurrences Such data may help patients participate in clinical decision-making regarding their arrhythmia. Listed in the table are the different types of cardiac monitoring devices available for clinical use
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