Abstract
BackgroundDue to limited data, implantable loop recorders (ILR) are not currently recommended by the guidelines to routinely monitor patients after atrial fibrillation (AF) ablation.AimsTo validate the diagnostic value of ILR after AF ablation, modern generation ILRs (LINQ) were implanted in patients scheduled for cryoballoon ablation of AF (CBA).MethodsWe included 29 patients with frequent and symptomatic episodes of paroxysmal AF. ILR was implanted 3 months prior to CBA, and data were collected before and for 6 months after the procedure. The device was programmed to maximize sensitivity of AF/ atrial tachycardia (AT) detection. All EGM recordings were “manually” assessed and annotated as true AF, pseudo AF, unrecognized AF, and episodes with no EGM available. Duration and episode‐based standard performance metrics were evaluated.ResultsA total number of 5,842 episodes were recorded. A total of 4,403 episodes were true AF, 453 episodes were pseudo AF, and 986 episodes had no EGM available. The device did not recognize 144 episodes of AF. Duration‐based sensitivity was 95.2%, duration‐based specificity 99.9%, duration‐based PPV 99.2%, duration‐based NPV 99.9%, episode‐based sensitivity 98.0%, and episode‐based PPV 91.0%. Misdiagnosis happened in 1 in 10 episodes. Total data review time was 166 hr.ConclusionsImplantable loop recorders is a valuable tool in evaluation of AF episodes in patients undergoing CBA. However, for high precision all recorded episodes need to be evaluated “manually.” The memory storage space is too low for frequent AF episodes, resulting in overwriting of stored EGMs and data loss.
Highlights
Implantable loop recorders (ILR) are currently recommended in various clinical situations when long-term cardiac monitoring is needed
To validate the clinical value of implantable loop recorders (ILR) after AF ablation, we decided to implant modern generation devices in patients scheduled for cryoballoon ablation of atrial fibrillation (CBA)
With no recorded EGMs, there is no possibility to verify diagnosis made by ILR, and as we indicated, automatic diagnosis could not be fully trusted
Summary
Implantable loop recorders (ILR) are currently recommended in various clinical situations when long-term cardiac monitoring is needed. These devices have proven to be a useful tool in the diagnosis and treatment of heart palpitations, unexplained syncope, cryptogenic stroke, or ventricular arrhythmias. They seem to be the perfect method of monitoring patients undergoing atrial fibrillation (AF) ablation (Pokushalov et al, 2011; Task Force Members, Brignole, Vardas, & Hoffman, 22009). Accurate information regarding arrhythmia episodes, arrhythmia types, and correlation with symptoms could help indicate patients who need redo ablation and guide pharmacological treatment. To validate the clinical value of ILR after AF ablation, we decided to implant modern generation devices in patients scheduled for cryoballoon ablation of atrial fibrillation (CBA)
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