Use of an Implantable Monitor to Detect Arrhythmia Recurrences and Select Patients for Early Repeat Catheter Ablation for Atrial Fibrillation: A Pilot Study
What is the clinical value of a redo procedure early after radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF)?
An implantable loop recorder (ILR) was implanted in 286 patients (mean age 56 years) who underwent RFCA of PAF. The ablation strategy was pulmonary vein isolation by circumferential ablation plus mitral isthmus and roof lines. Patients with recurrent PAF detected by the ILR during the first 3 months of follow-up (n = 167) were randomly assigned to antiarrhythmic drug therapy or redo RFCA after 3 months of follow-up (group 1, n = 83) or early redo RFCA if monitoring demonstrated AF initiation by premature atrial depolarizations or atrial tachycardia (group 2, n = 84). All patients were followed for 1 year. The primary endpoint was a PAF burden <0.5%/month during follow-up.
Triggered-onset PAF was documented by the ILR in 54/84 patients (62%) in group 2. These 54 patients underwent redo ablation at a mean of 21 days of follow-up. At 1 year, the primary endpoint was reached in 33% of patients in group 1 compared to 80% of patients in group 2. Among the 119 patients who did not have PAF during the first 3 months of follow-up, 94% reached the primary endpoint.
An early recurrence of PAF after ablation is a strong predictor of long-term recurrences. An early redo ablation procedure is appropriate when there is evidence of PAF triggers by monitoring.
The results suggest that early recurrences of triggered-onset PAF are an indicator of pulmonary vein reconnection, and may be a reasonable indication for early redo ablation.
Keywords: Recurrence, Follow-Up Studies, Health Resources, Pulmonary Veins, Catheter Ablation, Tachycardia
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