Continuous monitoring after atrial fibrillation ablation: the LINQ AF study

Simon Wechselberger, Mads Kronborg, Yan Huo, Judith Piorkowski, Sebastian Neudeck, Ellen Päßler, Ali El-Armouche, Utz Richter, Julia Mayer, Stefan Ulbrich, Liying Pu, Bettina Kirstein, Thomas Gaspar, Christopher Piorkowski, Simon Wechselberger, Mads Kronborg, Yan Huo, Judith Piorkowski, Sebastian Neudeck, Ellen Päßler, Ali El-Armouche, Utz Richter, Julia Mayer, Stefan Ulbrich, Liying Pu, Bettina Kirstein, Thomas Gaspar, Christopher Piorkowski

Abstract

Aims: To 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 results: In 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.

Conclusion: We suggest AF detection duration >6 min and AF burden >0.1% as a standardized outcome definition for AF studies to come in the future.

Figures

Figure 1
Figure 1
Continuous recurrence analysis: time to first AF episode ≥2, ≥6, and ≥10 min, after a 3 month blanking period. AF, atrial fibrillation.
Figure 2
Figure 2
Discontinuous monthly recurrence analysis: proportion of patients with any AF episode (≥2 min) assessed within each of the 24 post-interventional months. Patients with ‘de novo recurrences’ are shown in red. AF, atrial fibrillation.
Figure 3
Figure 3
Case examples of the six individual rhythm profiles (A–F). AF, atrial fibrillation; AT, atrial tachycardia.

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Source: PubMed

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