ABLATION OF PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION: LONG-TERM RECURRENCE RATES VIA CONTINUOUS SUBCUTANEOUS MONITORING
S. Bayramova, D. Losik, A. Strelnikov, A. Romanov, E. Pokushalov, S. Artyomenko, N. Shirokova, A. Karaskov, S. Mittal, J. Steinberg
Arrhythmia Department and Electrophysiology Laboratory, State Research Institute of Circulation Pathology, Novosibirsk, Russia. The Valley Health System and Columbia University, New York, NY, USA
Introduction: Concerns have been raised that over prolonged follow-up, initial responders to ablation of atrial fibrillation (AF) may recur very late post-procedure, even years after. Existing data, however, are limited to symptomatic events or at best, intermittent Holter or event recordings. The aim of this prospective observational study was to comprehensively track recurrence rates over 3 years post-ablation using implantable loop recorders (ILRs).
Methods: One hundred twenty nine patients with symptomatic drug refractory AF (45% with persistent AF) were enrolled. All patients underwent circumferential pulmunary vein isolation (PVI) with ILRs inserted for continuous AF monitoring during the 36-month follow-up. AF freedom was defined as AF%<0.5%.
Results: Complete PVI was achieved in 100% of cases. With a single procedure at the 12-month follow-up, 76 (59%) of the 129 patients were AF-free: 48 out of 71 (68%) in the paroxysmal AF group and 28 out of 58 (48%) in the persistent AF group. At the 36-month, 43 (33%) of the 129 patients were AF-free: 29 out of 71 (41%) in the paroxysmal AF group and 14 out of 58 (24%) in the persistent AF group.
A second procedure was performed in 41 (32%) and a 3rd in 6 (5%) patients. After the final ablation, 78 (60%) of the 129 patients were AF-free at 36 mos: 56 out of 71 (65%) in the paroxysmal AF group and 32 out of 58 (55%) in the persistent AF group. In the overall population, the AF% dramatically decreased by 6-months, followed by a plateau and a gradual increase after 16 months. 11 patients (21%) of the non-responders were completely asymptomatic. Progression to longstanding persistent AF was observed in 18 patients (14%).
Conclusions: Although ablation is effective in treating AF, there is a signficant attrition rate as assessed through detailed 3-year continuous ILR monitoring. Prior studies underestimated very late recurrences and failed to account for asymptomatic patients. The use of ILRs is a valuable means of identifying responders and non-responders, and can potentially guide therapies.
