scholarly journals Detection of atrial fibrillation recurrences after ablation: long-term intermittent versus short continuous heart rhythm monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N.L Hermans ◽  
M Gawalko ◽  
N.A.H.A Pluymaekers ◽  
T Dinh ◽  
B Weijs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Diagnostic Algorithm ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Af Ablation ◽  
System Usability Scale ◽  
System Usability ◽  
Rhythm Monitoring

Abstract Background Catheter based ablation therapy is an established treatment in patients with symptomatic atrial fibrillation (AF). Currently, the detection of AF recurrences after AF ablation is most frequently performed by short continuous heart rhythm monitoring, such as Holter monitoring. Our aim is to evaluate the effectiveness and accurateness of long-term intermittent rhythm monitoring using a single-lead ECG (AliveCor Kardia®) compared to short continuous monitoring with Holter for the detection of AF recurrences after ablation. Methods We conducted a prospective study of patients after AF ablation between May 2017 and October 2019. As standard of care, patients underwent Holter monitoring (minimum 24 hours) at 3, 6 and 12 months after ablation. At the same time patients were instructed to use an AliveCor Kardia (ACK) monitor to record a 30-second ECG three times a day and in case of symptoms for a period of four weeks. The primary endpoint was the difference in proportion of AF recurrences detected by ACK compared to Holter. Secondary endpoint was the sensitivity and specificity of ACK algorithm. Further, patients were asked to complete a questionnaire on the System Usability Scale to evaluate the usability for both ACK and Holter. Results Out of 126 post-ablation patients, 115 (91%) patients (35 female, age 63±8 years) transmitted their ACK recordings and were included in this analysis. A total of 7838 ECGs were assessed. The mean AKC usage time was 27+11 days, mean number of recordings 68+28 per patient. Our primary endpoint, the proportion of detection of recurrent AF, was almost twice as high in ACK (24%) than in Holter (14%, p<0.05). The ACK algorithm categorized 80% as normal sinus rhythm, 10% as possible AF, 10% as unclassified and 0.6% as unreadable. According to the interpretation of the researchers' team, 38 (0.5%) ECGs were uninterpretable and in 98% of the unclassified ECGs by ACK, the researchers' team was able to establish a diagnosis. The ACK diagnostic algorithm displayed a sensitivity of 95% and specificity of 98% for AF detection. The ACK diagnostic algorithm had a high likelihood of misclassifying premature atrial contractions and sinus rhythm accompanied by artifacts as AF (6.8% and 11% of all recordings assessed by AKC as AF, respectively). Based on the System Usability Scale, patients rated ACK as more acceptable in daily usage than Holter (75.0% versus 58.6% had an overall score above 70%, respectively). Conclusions ACK effectively and accurately detects AF recurrences in patients who underwent AF ablation and has a high patients' acceptability compared to Holter monitoring. Long-term intermittent rhythm monitoring may provide a promising tool for rhythm follow-up after AF ablation procedures. Interpretation of ACK recordings Funding Acknowledgement Type of funding source: None

scholarly journals Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001718
Author(s):  
Bart A Mulder ◽  
Meelad I H Al-Jazairi ◽  
Federico T Magni ◽  
Hessel F Groenveld ◽  
Robert G Tieleman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Area Under The Curve ◽  
Holter Monitoring ◽  
Underlying Disease ◽  
Volume Index ◽  
Left Atrium Volume

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

Abstract 4307: New Insights into Surgical Atrial Fibrillation Ablation Therapy: Initial Experience with a Novel Permanently Implantable Heart Rhythm Monitor Device

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thorsten Hanke ◽  
Antje Karlub ◽  
Efstratios Charitos ◽  
Axel Hagemann ◽  
Bernhard Graf ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Ecg Monitoring ◽  
Time Intervals ◽  
Ablation Therapy ◽  
Implantable Monitor ◽  
Monitor Device ◽  
Rhythm Monitoring ◽  
Af Recurrence

Introduction: Surgical atrial fibrillation (AF) therapy is gaining widespread acceptance among cardiothoracic surgeons. However, assessment of therapy success is until now solely based on short time -“snapshot”-rhythm surveillance often at irregular time intervals. In order to evaluate the ablation’s success we intraindividually compared two different types of follow-up strategies: conventional 24h-Holter monitoring and direct long time rhythm surveillance achieved by a new implantable monitor device (IRMD). Methods: 20 cardiac surgical patients (male 16, mean age 69±9y) with a mean AF of 30±48m (paroxysmal n=7, persistent n=9, long standing persistent n=4) were treated intraoperatively with epicardial high intensity focus ultrasound (HIFU) ablation (+CABG n=10, +AVR n=5, +AVR/CABG n=2, +valve preserving ascending aorta replacement n=2, +endoaneurymoraphy n=1, lone atrial fibrillation n=1). Postoperative heart rhythm monitoring was accomplished in all patients with a 24h-Holter-monitor at prescheduled time intervals and additionally with a new implantable monitor device (Reveal XT, Medtronic®, MN, USA). A more than 0.5% of “time in AF” as reported by the IRMD was considered as recurrence of AF. Telemetry of the IRMD was performed simultaneously after completion of 24h-Holter monitoring. Results: During a mean FU of 8.7±1.4m a total of 29 24 h-Holter-monitors were obtained. Sinus rhythm was documented in 21, the IMRD however revealed AF recurrence in 11 of these cases. Thus, conventional 24 h ECG monitoring failed to identify AF recurrence in 59% of cases (p<0.027). Success rate after surgical ablation therapy (defined as freedom from AF recurrence of more than 0.5% of observational period) was 72% with 24h Holter monitoring, but only 35% using continuous ECG monitoring with IRMD. Conclusion: In order to evaluate better “real life” outcomes after atrial fibrillation ablation therapy, long term continuous heart rhythm surveillance instead of -“snapshot” - heart rhythm monitoring is mandatory. This is particularly important for the decision to alter medical therapies, e.g. oral anticoagulation or antiarrhythmic treatment.

scholarly journals Pharmacological cardioversion of atrial fibrillation paroxysm in elderly and senile patients at prehospital stage

2021 ◽  
Vol 2 (3) ◽  
pp. 26-32
Author(s):  
Andrei V. Syrov ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Heart Rhythm ◽  
Day Hospital ◽  
Drug Of Choice ◽  
Wide Range ◽  
Rhythm Disorder ◽  
Pharmacological Cardioversion ◽  
High Level

Atrial fibrillation (AF) is the most common heart rhythm disorder requiring treatment and is associated with an increased rate of hospitalization and death. When choosing the tactics of restoring and maintaining sinus rhythm in most patients with AF paroxysm without pronounced organic heart damage, the drug of choice is propafenone, which has a high level of safety and efficacy. The use of the drug within the framework of a «pill in a pocket» by the patient himself, intravenously in a day hospital of an outpatient medical institution or by an ambulance team allows stopping AF paroxysm in most patients at the prehospital stage. Propafenone is also the drug of choice for inpatient sinus rhythm restoration and for long-term antiarrhythmic therapy in a wide range of patients with AF.

scholarly journals Long-term outcomes after surgical ablation for atrial fibrillation in patients with continuous heart rhythm monitoring devices

2015 ◽  
pp. ivv248 ◽  
Author(s):  
Efstratios I. Charitos ◽  
Paul D. Ziegler ◽  
Ulrich Stierle ◽  
Bernhard Graf ◽  
Hans-Hinrich Sievers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Long Term Outcomes ◽  
Surgical Ablation ◽  
Monitoring Devices ◽  
Rhythm Monitoring

scholarly journals Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Roland Richard Tilz ◽  
Nikolaos Dagres ◽  
Elena Arbelo ◽  
Carina Blomström-Lundqvist ◽  
Harry J Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Atrial Fibrillation Ablation ◽  
Left Ventricular Ejection ◽  
Web Based ◽  
Ventricular Ejection Fraction ◽  
Af Ablation ◽  
Atrial Size

Abstract Aims Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection. Methods and results Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P &lt; 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P &lt; 0.001) but with European Heart Rhythm Association (EHRA) scores &gt;1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P &lt; 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P &lt; 0.001 each). Conclusion The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.

scholarly journals Left atrial dysfunction still exists in patients who obtain normal left atrial volume after successful ablation of atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Kawakami ◽  
K Inoue ◽  
T Nagai ◽  
A Fujii ◽  
Y Sasaki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Late Recurrence ◽  
Reverse Remodeling ◽  
Long Term Outcomes ◽  
Af Ablation ◽  
Af Recurrence

Abstract Introduction Atrial fibrillation (AF) promotes left atrial (LA) remodeling and vice versa. LA volume index (LAVI) ≥34 mL/m2 is an established cut-off value for identifying an enlarged left atrium. Catheter ablation has become an established therapy for AF and provides a reduction of LA volume by maintaining sinus rhythm (reverse remodeling). However, the definition of LA reverse remodeling after AF ablation is undetermined. Purpose We hypothesized that patients with LA dilatation who obtain normal LA volume (LAVI &lt;34 mL/m2) after AF ablation would have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume could also obtain normal LA function with AF ablation. Methods We enrolled 140 AF patients with baseline LAVI ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 h and at 1 year after the procedure. Late recurrence was defined as AF recurrence &gt;1 year after the initial ablation. To define the normal range of LA function, age-and sex-matched 140 controls without a history of AF were also enrolled. Results After restoration of sinus rhythm, overall LA structural and functional parameters were significantly improved, and 75 patients (54%) had normal LA volume at the time of follow-up (Table). During a median follow-up of 44 (31–61) months, 32 patients (23%) experienced a late recurrence of AF. Patients who obtained normal LA volume after AF ablation had fewer late recurrences than those who did not (P&lt;0.01) (Figure). However, LA functional abnormalities still existed in AF patients, even if LA volume was normalized as in controls (Table). Conclusion Patients who obtain normal LA volume have better long-term outcomes of AF ablation than those who do not. Although AF ablation promotes beneficial effects on LA structure and function, LA function cannot be normalized even in patients who obtain normal LA volume after successful ablation. Thus, physicians should carefully consider long-term follow-up and residual AF risks, regardless of sinus rhythm restoration by catheter ablation. FUNDunding Acknowledgement Type of funding sources: None.

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