title: Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study.
abstract: BACKGROUND
  The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation.
  
  
  METHODS
  Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms.
  
  
  RESULTS
  Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (P < .001), and 56.0% of all episodes were asymptomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P = .002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF.
  
  
  CONCLUSIONS
  The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00745706.
authors.affiliation: Department of Cardiology, Southlake Regional Health Centre, 105-712 Davis Dr, Newmarket, ON L3Y 8C3, Canada. atul.verma@utoronto.ca
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Jean
authors.initials: J
authors.lastname: Champagne
authors.forename: John
authors.initials: J
authors.lastname: Sapp
authors.forename: Vidal
authors.initials: V
authors.lastname: Essebag
authors.forename: Paul
authors.initials: P
authors.lastname: Novak
authors.forename: Allan
authors.initials: A
authors.lastname: Skanes
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: David
authors.initials: D
authors.lastname: Birnie
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology / Q000628:therapy; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000628:therapy*; D001282:Atrial Flutter / Q000453:epidemiology / Q000628:therapy; D002170:Canada / Q000453:epidemiology; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome