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. 2021 Apr 28;2(3):255-261.
doi: 10.1016/j.hroo.2021.04.003. eCollection 2021 Jun.

Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation

Gary Peng  1   2 , Aung N Lin  1   2 , Edmond Obeng-Gyimah  1   2 , Samantha N Hall  1   2 , Ya-Wen Yang  1   2 , Shiquan Chen  1   2 , Michael Riley  1   2 , Rajat Deo  1   2 , Aasima Ali  1   2 , Jeffery Arkles  1   2 , Andrew E Epstein  1   2 , Sanjay Dixit  1   2
Affiliations

Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation

Gary Peng et al. Heart Rhythm O2. .

Abstract

Background: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%-50% in these patients.

Objectives: To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population.

Methods: Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation.

Results: A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7-17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23-72) in the CM group (P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation.

Conclusion: Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population.

Keywords: Arrhythmia detection and monitoring; CTI-dependent atrial flutter; Implantable loop recorder; New-onset atrial fibrillation; Typical atrial flutter.

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Figures

Figure 1
Figure 1
Kaplan-Meier curves showing time to atrial fibrillation detection by implantable loop recorders vs conventional monitoring.
See this image and copyright information in PMC

References

    1. January C.T., Wann L.S., Calkins H. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140:e125–e151. - PubMed
    1. Page R.L., Joglar J.A., Caldwell M.A. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016;133:e506–e574. - PubMed
    1. Tomson T.T., Kapa S., Bala R. Risk of stroke and atrial fibrillation after radiofrequency catheter ablation of typical atrial flutter. Heart Rhythm. 2012;9:1779–1784. - PubMed
    1. Chinitz J.S., Gerstenfeld E.P., Marchlinski F.E., Callans D.J. Atrial fibrillation is common after ablation of isolated atrial flutter during long-term follow-up. Heart Rhythm. 2007;4:1029–1033. - PubMed
    1. Philippon F., Plumb V.J., Epstein A.E., Kay G.N. The risk of atrial fibrillation following radiofrequency catheter ablation of atrial flutter. Circulation. 1995;92:430–435. - PubMed

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