title: Use of an implantable monitor to detect arrhythmia recurrences and select patients for early repeat catheter ablation for atrial fibrillation: a pilot study.
abstract: BACKGROUND
  Catheter ablation of atrial fibrillation (AF) has proved effective in curing highly symptomatic patients with paroxysmal AF. The aim of this prospective, randomized study was to identify the optimal treatment of patients with AF recurrences after the first ablation.
  
  
  RESULTS
  Two hundred eighty-six patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions) and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic). Patients without AF recurrences during the 3-month postablation period were assigned to group 1; those with AF recurrences to group 2. Patients in group 2 were randomly assigned to group 3 or group 4. Group 3 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 4 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess maintenance of sinus rhythm in each group. On 12-month follow-up examination, of the 119 (42%) patients in group 1, 112 (94%) had no AF recurrences. Among the 83 patients in group 3, only 27 (33%) had no recurrences. Of the 84 group 4 patients, 67 (80%) had no AF recurrences (P<0.0001 versus group 3).
  
  
  CONCLUSIONS
  Patients with recurrences after the first AF ablation are likely to respond to a second early ablation when AF is triggered by supraventricular arrhythmias or premature contractions.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164319.
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russia. E.Pokushalov@gmail.com
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.forename: Giorgio
authors.initials: G
authors.lastname: Corbucci
authors.forename: Sergey
authors.initials: S
authors.lastname: Artyomenko
authors.forename: Alex
authors.initials: A
authors.lastname: Turov
authors.forename: Natalya
authors.initials: N
authors.lastname: Shirokova
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012426:Russia; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents