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 Atrial fibrillation detection using single lead portable electrocardiographic monitoring: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e024178 ◽  
Author(s):  
Satish Ramkumar ◽  
Nitesh Nerlekar ◽  
Daniel D’Souza ◽  
Derek J Pol ◽  
Jonathan M Kalman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Detection Rate ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Significant Heterogeneity ◽  
Ecg Monitoring ◽  
Quality Of Reporting ◽  
Electrocardiographic Monitoring ◽  
Monitoring Time ◽  
Meta Regression

ObjectivesRecent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.Setting, participants and outcome measuresWe searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.ResultsPortable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.ConclusionPortable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.PROSPERO registration numberCRD42017061021.

scholarly journals Diagnostic utility of long-term remote ECG monitoring in compare with 24 hour Holter monitoring in patients with atrial fibrillation after catheter radiofrequency ablation in the early postoperative period

2018 ◽  
Vol 90 (12) ◽  
pp. 12-16
Author(s):  
G V Ryabykina ◽  
Z O Shokhzodaeva ◽  
O V Sapelnikov ◽  
M I Makeev ◽  
E Sh Kozhemyakina ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Remote Monitoring ◽  
Pulmonary Veins ◽  
Holter Monitoring ◽  
Early Postoperative Period ◽  
Diagnostic Utility ◽  
Ecg Monitoring ◽  
Af Recurrence

Aim. To evaluate the diagnostic utility of long-term remote monitoring of ECG compared with 24 hour Holter monitoring for the detection of cardiac arrhythmias and conduction disturbance in patients with atrial fibrillation (AF) after catheter radiofrequency ablation (RFA; isolation) of the pulmonary veins. Materials and methods. The study included 62 patients aged 58.5±11.1 years, with paroxysmal or persistent AF, after catheter RFA (pulmonary veins isolation). Patients underwent long-term remote ECG monitoring, 24 hour Holter monitoring and transthoracic echocardiogram. Results and discussion. After 24 hour Holter monitoring of 62 patients with AF after RFA in 21 of them (33.9%) was detected early recurrence of AF. Remote ECG monitoring of 18 patients, detected AF in 7 patients (39%), 2 of them were asymptomatic AF recurrence. 24 hour Holter monitoring of the same 18 patients AF recurrence was not detected at all (0%). Conclusion. Both of devices, long-term remote monitoring of ECG and 24 hour Holter monitoring detected 45.2% of recurrence of AF. Over the wearing of both devises 24 hour Holter and long-term remote monitor the last detected more events among 18 patients (33% vs 0%). Two evens of AF recurrence were asymptomatic.

scholarly journals Autonomic nervous modulation after cryoballoon ablation for paroxysmal atrial fibrillation

2021 ◽  
Vol 28 (1) ◽  
pp. 38-46
Author(s):  
I. A. Novikov ◽  
P. S. Novikov ◽  
N. U. Mironov ◽  
M. A. Shariya ◽  
S. F. Sokolov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Early Recurrence ◽  
Cryoballoon Ablation ◽  
Autonomic Nervous ◽  
One Year ◽  
Af Recurrence

Aim. Aim of our study was the assessment of autonomic nervous system (ANS) modulation by assessment of heart rhythm variation (HRV) using Holter monitoring after single second generation cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF).Methods. Patients who underwent the CBA for paroxysmal AF were include in this study. At the baseline the Holter monitoring after withdrawal of antiarrhythmic therapy (AAT) with assessment of HRV: SDNN, RMSSD, ln LF, ln LH, LH/HF, mean, minimal and maximal beats per minute (BPM) was perform. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months including Holter monitoring.Results. Among 80 patients underwent CBA, HRV was assessed in 55 patients (65.5% male, age median 61 years, 97.7% of pulmonary vein have been successful isolated). One year after CBA all HRV parameters and the mean, minimal and maximal BPM was significantly different from baseline parameters (p<0.05). In the AF recurrence group ln LF was lower at 3-, 6and 12-month visits (p<0.05) and minimal HR was higher at 3 months (median 58 vs 55.5, p=0.033). Multivariate analysis demonstrated that early recurrence of AF was independent predictor of AF recurrence after CBA (HR 7,44, 95% CI 2,19-25,25, р=0,001).Conclusion. Our study demonstrated that CBA leads to modulation of ANS which persists for at least 12 months. The early recurrence of AF was only predictor of AF recurrence after CBA.

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&lt;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 Holter Monitoring and Loop Recorders: From Research to Clinical Practice

2016 ◽  
Vol 5 (2) ◽  
pp. 136 ◽  
Author(s):  
Alessio Galli ◽  
Francesco Ambrosini ◽  
Federico Lombardi ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrhythmias ◽  
Cardiac Rhythm ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Cardioverter Defibrillator ◽  
Proven Efficacy ◽  
Prolonged Monitoring ◽  
Monitoring Technologies

Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.

Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sebasigari ◽  
Alexander Merkler ◽  
Guo Yang ◽  
Benjamin Kummer ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Population Based ◽  
Embolic Stroke ◽  
P Wave ◽  
Left Atrial Diameter ◽  
New Diagnosis ◽  
Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

scholarly journals Does Reversible AF Exist? Or is AF Just AF?

2018 ◽  
Vol 13 (SP1) ◽  
Author(s):  
Michael Quon ◽  
Louise Pilote
Keyword(s):  
Atrial Fibrillation ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Heart Rhythm ◽  
Management Approaches ◽  
Term Management ◽  
Af Recurrence

Self-limited or transient atrial fibrillation (AF) occurring during an acute reversible, precipitant has been referred to as secondary AF, temporary cause of AF (TCAF), and AF occurring transiently during stress (McIntyre et al).  Alternatively, it has been classified as either ‘reversible’ versus ‘provoked’ AF, varying in terms of underlying cardiac substrate and risk for AF recurrence.  Given it was described in prior American Heart Association / American College of Cardiology / Heart Rhythm Society guidelines, we continue using the defining term ‘secondary AF’.   In this article, we review prior studies and provide an overview of long-term management approaches to secondary AF.  We will use the term ‘primary AF’ to describe established AF, without an associated secondary cause.  

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