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Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Faculty of Medicine and Health, Örebro University, Örebro, Sweden. (Clinical Epidemiology and Biostatistics)
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2016 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 9, p. 914-925Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.

Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.

Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.

Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.

Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.

Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2016. Vol. 39, no 9, p. 914-925
Keywords [en]
Atrial fibrillation, catheter ablation, implantable loop recorder, monitoring, symptoms
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-51530DOI: 10.1111/pace.12916ISI: 000383572900002PubMedID: 27418324Scopus ID: 2-s2.0-84987723704OAI: oai:DiVA.org:oru-51530DiVA, id: diva2:950980
Note

Funding Agencies:

Medtronic

Örebro heart foundation

Research Committee of Örebro University Hospital, Örebro, Sweden

Available from: 2016-08-04 Created: 2016-08-02 Last updated: 2018-09-18Bibliographically approved
In thesis
1. Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
Open this publication in new window or tab >>Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: AF ablation is an increasingly used treatment in patients with AF to improve patient-reported outcomes (PROs). Atrioventricular junction ablation (AVJA) is a palliative treatment option in therapy refractory AF that improves PROs but renders the patient pacemaker dependent.

Aims: To evaluate rhythm control and PROs before and up to two years after AF ablation. To analyze the long-term incidence of and predictors of hospitalization for HF and all-cause mortality in patients who underwent AVJA and right ventricular pacing.

Methods and Results: Fifty-four patients underwent AF ablation and both continuous rhythm monitoring via an implantable loop recorder (ILR) and intermittent rhythm monitoring three, six, 12 and 24 months after ablation. 76 % of patients had at least one AF recurrence, of whom 24 % were only detected by ILR. One third of symptom recordings did not show AF. The AF-specific AF6 scores, physician-assessed EHRA symptom class and both SF-36 summary scores all improved significantly from before to two years after ablation. There was a weak correlation between the change in AF6 scores and EHRA class from before to six and 12 months but not to 24 months after ablation. Responders to ablation (AF burden < 0.5 %), reached age- and sex-matched norms in all SF-36 domains, but non-responders only in social functioning and MCS. All AF6 scores showed at least moderate improvement in both responders and non-responders. Higher AF burden was independently associated with poorer PCS and AF6 scores. In 162 patients who underwent AVJA, hospitalization for HF occurred in 20 % of patients (two-year cumula-tive incidence 9.1 %) and 22 % died (two-year cumulative incidence 5.2 %) during a median follow-up of five years. QRS ≥ 120 ms and left atrial diame-ter were independent predictors of hospitalization for HF, and hypertension and previous HF of death.

Conclusions: Continuous rhythm monitoring was superior to intermittent monitoring. The AF-specific AF6 was more sensitive to changes related to AF burden after AF ablation than both EHRA class and the SF-36. The long-term hospitalization rate for HF and all-cause mortality was low after AVJA.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 92
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 175
Keywords
Atrial fibrillation, catheter ablation, symptoms, quality of life
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-65015 (URN)978-91-7529-237-3 (ISBN)
Public defence
2018-04-20, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-03-28Bibliographically approved

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Björkenheim, AnnaPoçi, Dritan

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