For shock-resistant AF, traditional measures ‘fail to capture’ ablation’s true benefit
Click Here to Manage Email Alerts
Key takeaways:
- Patients with persistent atrial fibrillation saw a significant decline in atrial tachyarrhythmia burden after ablation.
- Implantable device data captured benefits not typically measured by persistent AF analyses.
Implantable device data show patients with shock-resistant atrial fibrillation fare better than conventional analyses demonstrate, experiencing a marked reduction in atrial tachyarrhythmia burden despite modest arrhythmia-free survival.
“Persistent AF patients represent a challenging cohort who have suboptimal results from catheter ablation,” Louisa O’Neill, MD, PhD, cardiologist at AZ Sint-Jan Hospital in Bruges, Belgium, and colleagues wrote. “Nevertheless, traditional measures of success may fail to capture the benefit derived from ablation in this cohort. This study demonstrates a significant reduction in atrial tachyarrhythmia burden after ablation, measured with the use of continuous implantable cardiac monitoring, and underscores the value of ablation even in those with true shock-resistant, persistent AF.”
Image: Adobe Stock
O’Neill and colleagues analyzed data from 60 patients with drug-resistant, ongoing persistent AF and at least one previous failed cardioversion, who received an implantable cardiac monitor 2 months before undergoing catheter ablation. The mean age of patients was 67 years; 70% were men. Mean left atrial diameter was 48 mm and median CHA2DS2-VASc score was two. All patients underwent pulmonary vein isolation with or without additional substrate ablation depending on the presence of self-terminating AF on implantable cardiac monitor and left atrium size. Researchers assessed median AF burden before and after ablation, off antiarrhythmic medication, determined from implantable cardiac monitor recordings.
The findings were published in JACC: Clinical Electrophysiology.
Within the cohort, 17% unexpectedly demonstrated self-terminating AF before ablation.
The median burden of atrial tachyarrhythmia before ablation was 100%, decreasing to 0% (95% CI, 0-95.8) after ablation during the post-blanking follow-up period. The median reduction was 100% (95% CI, 4-100; P < .001). During 12 months of follow-up, 45% experienced recurrent atrial tachyarrhythmia. Among those patients, the median burden before ablation was 100%, decreasing to 11.4% after ablation (95% CI, 0.35-99.7; P < .001).
Quality of life improved significantly from baseline, driven by lack of recurrence, according to the researchers.
“This study suggests that continuous implantable cardiac monitor-based monitoring provides useful information on the type and pattern of AF, reflecting underlying atrial arrhythmia substrate, which may help guide ablation strategy in the future,” the researchers wrote. “Furthermore, continuous monitoring by either prolonged Holter monitoring or implantable cardiac monitoring may represent the most optimal method by which to assess post-ablation outcome in persistent AF patients in future trials.”
Collapse
Read more about
Click Here to Manage Email Alerts