title: Symptomatic and asymptomatic long-term recurrences following transcatheter atrial fibrillation ablation.
abstract: BACKGROUND
  Atrial fibrillation (AF) relapses, following transcatheter AF ablation, are frequently reported based on patients' symptoms, scheduled electrocardiograms (ECGs), or 24-hour Holter recordings. The aim of this study is to determine the incidence of asymptomatic and symptomatic AF recurrences, using continuous subcutaneous ECG monitoring, in the long-term follow-up of patients with paroxysmal or persistent AF undergoing transcatheter ablation.
  
  
  RESULTS
  In total 113 consecutive patients symptomatic for paroxysmal or persistent AF were enrolled. All patients underwent pulmonary vein isolation plus left linear lesions. The insertable cardiac monitor (ICM), subcutaneously implanted during the ablation procedure, recorded the amount of AF per day (daily burden) and per last follow-up period (total AF burden). Based on symptoms and on scheduled 12-lead ECG performed during follow-up, 40 patients (35.4%) suffered AF recurrences. By means of ICM data, however, arrhythmia relapses were recorded within 75 patients (66.3%), of whom 35 (46.7%) were asymptomatic. Patients suffering symptomatic AF recurrences resulted, at univariate analysis, older (66.6 ± 8.4 years vs 61.6 ± 10.7 years) and suffering greater AF burden (88.8 ± 26.9% vs 8.0 ± 8.0%).
  
  
  CONCLUSIONS
  AF ablation outcome based on patients' symptoms and/or scheduled ECGs underestimated relapses, as up to half of the patients, during a long-term follow-up, suffer asymptomatic recurrences.
authors.affiliation: Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Manganiello
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Claudia
authors.initials: C
authors.lastname: Amellone
authors.forename: Elisa
authors.initials: E
authors.lastname: Pelissero
authors.forename: Marco
authors.initials: M
authors.lastname: Giuggia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trapani
authors.forename: Benedetta
authors.initials: B
authors.lastname: Giordano
authors.forename: Gaetano
authors.initials: G
authors.lastname: Senatore
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D063189:Symptom Assessment; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: asymptomatic recurrences; paroxysmal and persistent atrial fibrillation; transcatheter ablation