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. 2020 Oct 29;1(3):114-122.
doi: 10.1016/j.cvdhj.2020.10.003. eCollection 2020 Nov-Dec.

Incidence, duration, pattern, and burden of de novo atrial arrhythmias detected by continuous ECG monitoring using an implantable loop recorder following ablation of the cavotricuspid isthmus

Dan L Musat  1 , Nicolle S Milstein  1 , Jacqueline Pimienta  1 , Advay Bhatt  1 , Mark W Preminger  1 , Tina C Sichrovsky  1 , Laura Flynn  1 , Carissa Pistilli  1 , Richard E Shaw  1 , Suneet Mittal  1
Affiliations

Incidence, duration, pattern, and burden of de novo atrial arrhythmias detected by continuous ECG monitoring using an implantable loop recorder following ablation of the cavotricuspid isthmus

Dan L Musat et al. Cardiovasc Digit Health J. .

Abstract

Background: Following cavotricuspid isthmus (CTI) ablation, many patients with atrial flutter (AFL) are diagnosed with atrial fibrillation (AF). The incidence, duration, pattern, and burden of AF remain undefined. These may have implications for the management of these patients.

Objective: To classify the incidence, duration, pattern, and burden of AF/AFL using an implantable loop recorder (ILR) after CTI ablation.

Methods: We enrolled consecutive patients with CTI-dependent AFL, no known history of AF, and CHA2DS2-VASc ≥ 2. An ILR was implanted before or within 90 days of ablation. The time to first AF/AFL, pattern, duration, and burden of longest AF/AFL were determined. Five distinct AF/AFL cohorts were identified: no AF/AFL and those with recurrences of isolated, clustered, frequent, or persistent AF/AFL.

Results: Fifty-two patients (81% male; 73 ± 9 years; CHA2DS2-VASc 3.7 ± 1.2) were followed for 784 (interquartile range [IQR] 263, 1150) days. AF/AFL occurred in 44 (85%) patients at 64 (IQR 8, 189) days post-CTI ablation and was paroxysmal in 31 (70%) patients (burden 0.6% [IQR 0.1, 4.8]). AF/AFL was isolated (n = 5, 11%), clustered (n =7, 16%), frequent (n =19, 43%), and persistent (n =13, 30%). The longest AF episode was <24 hours in 27 (61%) patients.

Conclusion: Following CTI ablation in AFL patients, although AF/AFL occurs in most patients, the burden is low and episodes were <24 hours in the majority of patients. Additional studies are needed to determine whether long-term electrocardiographic monitoring can help guide management of patients undergoing CTI ablation.

Keywords: Atrial fibrillation; Atrial flutter; Catheter ablation; Cavotricuspid isthmus ablation; Implantable loop recorder.

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Figures

Figure 1
Figure 1
Patterns of atrial fibrillation (AF) and atrial flutter detected by loop recorder. A: Isolated: single AF episode followed by >6 months until another AF episode. B: Clusters: more than 1 episode of AF within a month followed by >6 months until another AF episode. C: Frequent: multiple AF episodes without any 6-month AF-free period. D: Persistent AF: AF lasting continuously for more than 7 days. AT = atrial tachycardia.
Figure 2
Figure 2
The incidence of atrial fibrillation / atrial flutter after ablation of the cavotricuspid isthmus.
Figure 3
Figure 3
Duration of longest episode of atrial fibrillation (AF) / atrial flutter observed following ablation of the cavotricuspid isthmus.
Figure 4
Figure 4
Pattern and longest episode duration of atrial fibrillation (AF) / atrial flutter after ablation of the cavotricuspid isthmus, stratified by pattern of arrhythmia recurrence.
Figure 5
Figure 5
True and false detection of an atrial arrhythmia. The lifetime burden and duration of longest atrial arrhythmia are summarized for each of the 4 groups, defined by presence or absence of false-positive detection of an atrial arrhythmia by the implantable loop recorder. AF = atrial fibrillation; AFL = atrial flutter.
Supplemental Figure
Supplemental Figure
Lifetime burden of atrial tachyarrhythmia after ablation of the cavotricuspid isthmus, stratified by pattern of arrhythmia recurrence.
See this image and copyright information in PMC

References

    1. Waldo A.L. Inter-relationships between atrial flutter and atrial fibrillation. Pacing Clin Electrophysiol. 2003;26:1583–1596. - PubMed
    1. Roithinger F.X., Lesh M.D. What is the relationship of atrial flutter and fibrillation? Pacing Clin Electrophysiol. 1999;22:643–654. - PubMed
    1. Page R.L., Joglar J.A., Caldwell M.A., et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. J Am Coll Cardiol. 2016;67:e27. - PubMed
    1. Spector P., Reynolds M.R., Calkins H., et al. Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. Am J Cardiol. 2009;104:671–677. - PubMed
    1. Mittal S., Pokushalov E., Romanov A., et al. Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter. Heart Rhythm. 2013;10:1598–1604. - PubMed

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