New insights into long-term follow-up of atrial fibrillation ablation: full disclosure by an implantable pacemaker device.
BACKGROUND
Long-term outcome of radiofrequency ablation (RFA) for atrial fibrillation (AF) is difficult to assess. This study sought to evaluate various aspects of very long-term follow-up (FU) by the properties of an implantable device.


METHODS
Fourteen patients with an implanted pacemaker device (Medtronic AT500) were selected for RFA, due to drug-refractory and highly symptomatic AF despite antibradycardic pacing.


RESULTS
With a mean FU of 41.4 +/- 15.1 months, we could achieve continuous monitoring for more than 400,000 hours after RFA. Based on symptomatic episodes, simulated 24-hour, 48-hour, or 7-day Holter, 57% to 71% of the patients were classified as RFA responders. With permanent FU provided by the implanted device, 43% of the patients exhibited a positive treatment effect and only 21% had no tachyarrhythmic episode at all in long-term FU. With a mean of 1.7 +/- 0.7 RFA per subject, atrial tachyarrhythmia burden (ATB) was significantly reduced from a median of 3.6 to 0.3 hours per day (P < 0.001). Two out of 14 patients developed AF recurrences after a tachyarrhythmia-free period of more than 12 months.


CONCLUSIONS
Continuous monitoring provided by an implantable device is able to detect significantly more AF episodes than routine FU. ATB is decreased significantly by (repeated) RFA over a very long-term FU. AF may reoccur very late after long-lasting (>1 year) episode-free intervals. A subgroup of patients with drug-aggravated bradycardia in brady-tachy syndrome might be considered for PV isolation rather than pacemaker implantation.
Martinek
Martin
M
Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Linz, Austria. martin.martinek@elisabethinen.or.at
Aichinger
Josef
J
Nesser
Hans-Joachim
HJ
Ziegler
Paul D
PD
Purerfellner
Helmut
H
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome