Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2023 Feb 16;25(2):676-681.
doi: 10.1093/europace/euac194.

Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey

Ana Carolina Schwab  1 , Ante Anic  2 , Michal M Farkowski  3 , Jose Guerra  4 , Konstantinos E Iliodromitis  5 , Kristine Jubele  6   7 , Rui Providencia  8   9 , Julian K R Chun  10 , Serge Boveda  11   12   13
Affiliations
Comment

Rhythm monitoring, success definition, recurrence, and anticoagulation after atrial fibrillation ablation: results from an EHRA survey

Ana Carolina Schwab et al. Europace. .

Abstract

Atrial fibrillation (AF) is a major challenge for the healthcare field. Pulmonary vein isolation is the most effective treatment for the maintenance of sinus rhythm. However, clinical endpoints for the procedure vary significantly among studies. There is no consensus on the definition of recurrence and no clear roadmap on how to deal with recurrences after a failed ablation. The purpose of this study was to perform a survey in order to show how clinicians currently approach this knowledge gap. An online survey, supported by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, was conducted between 1 April 2022 and 8 May 2022. An anonymous questionnaire was disseminated via social media and EHRA newsletters, for clinicians to complete. This consisted of 18 multiple-choice questions regarding rhythm monitoring, definitions of a successful ablation, clinical practices after a failed AF ablation, and the continuance of anticoagulation. A total of 107 replies were collected across Europe. Most respondents (82%) perform routine monitoring for AF recurrences after ablation, with 51% of them preferring a long-term monitoring strategy. Cost was reported to have an impact on the choice of monitoring strategy. Self-screening was recommended by most (71%) of the respondents. The combination of absence of symptoms and recorded AF was the definition of success for most (83%) of the respondents. Cessation of anticoagulation after ablation was an option mostly for patients with paroxysmal AF and a low CHA2DS2-VASc score. The majority of physicians perform routine monitoring after AF ablation. For most physicians, the combination of the absence of symptoms and electrocardiographic endpoints defines a successful result after AF ablation.

Keywords: Anticoagulation; Catheter ablation; EHRA survey; Recurrence; Rhythm monitoring.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: A.A. received consulting fees and speaking honoraria from Boston Scientific Inc., Farapulse Inc., Galaxy MedicalInc., and Biosense & Webster Contracted research from Boston Scientific Inc., Farapulse Inc., Galaxy Medical Inc., Biosense & Webster. M.M.F. received proctoring/speaker fees from BMS/Pfizer, Boehringer Ingelheim, Medtronic, Abbott, and Boston Scientific. S.B. is consultant for Medtronic, Boston Scientific, Microport, and Zoll. J.G. has served as consultant for Medtronic, Boston Scientific, Microport, and Abbott, received speaker fees from Medtronic, Boston Scientific, and Abbott, and received a research grant from Abbott.

Figures

Figure 1
Figure 1
Use of smartphones/wearables for recurrence monitoring after AF ablation (with more than one negative answer allowed).
Figure 2
Figure 2
Use of implantable loop recorders for recurrence monitoring after AF ablation (with more than one negative answer allowed).
Figure 3
Figure 3
Self-screening instructions to assess heart rate of patients.
Figure 4
Figure 4
Preferred therapy after a first failed AF ablation both in paroxysmal and persistent AF. *P < 0.05.
See this image and copyright information in PMC

Comment on

References

    1. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke 2021;16:217–21. - PubMed
    1. Burdett P, Lip GYH. Atrial fibrillation in the UK: predicting costs of an emerging epidemic recognizing and forecasting the cost drivers of atrial fibrillation-related costs. Eur Heart J Qual Care Clin Outcomes 2022;8:187–94. - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist Cet al. . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498. - PubMed
    1. Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba Wet al. . Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005;293:2634–40. - PubMed
    1. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga Let al. . 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018;20:e1–e160. - PMC - PubMed