[Assessment of atrial fibrillation ablation outcome: from symptoms to continuous monitoring with an implantable loop recorder].
Pulmonary vein isolation by catheter ablation (CA) is an effective and indicated treatment for patients with drug refractory symptomatic atrial fibrillation (AF). It is noteworthy that patients with symptomatic AF show also a high incidence of asymptomatic episodes of arrhythmia. The main clinical studies on CA of AF have considered symptomatic recurrences of AF as the primary endpoint, thus potentially overestimating the success rate. Patient monitoring by means of daily transtelephonic ECG or repeated 7-day Holter has demonstrated an incidence of asymptomatic episodes of AF as high as 50% of all arrhythmic recurrences after CA. Moreover, the percentage of asymptomatic episodes significantly increases after CA. Changes in arrhythmia pattern and autonomic nervous system together with placebo effects and post-interventional antiarrhythmic therapy could account for the increase in asymptomatic episodes of AF observed after CA. A watchful monitoring of AF recurrences is of extreme importance not only to assess the real overall efficacy of CA but also to tailor therapeutic strategies for the individual patient. The decision to withdraw anticoagulation and antiarrhythmic therapies should be based on the demonstrated absence of both symptomatic and asymptomatic recurrences. The use of an implantable loop recorder with a dedicated software for AF and atrial tachycardia detection could be a valuable alternative to current monitoring strategies after CA of AF. Patient acceptability of such a minimally invasive strategy for AF monitoring has still to be proven.
Rordorf
Roberto
R
Dipartimento di Cardiologia, Fondazione Policlinico San Matteo IRCCS, Pavia.
Vicentini
Alessandro
A
Landolina
Maurizio
M
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015994:Incidence; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D013610:Tachycardia / Q000175:diagnosis; D013686:Telemetry / Q000295:instrumentation / Q000379:methods*; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome