Vnitr Lek 2012, 58(9):633-639

A comparison of two methods of long-term external ECG telemonitoring in patients after ablation for atrial fibrillation

J. Chovančík¹, V. Bulková², M. Fiala^1,*, J. Gandalovičová², Š. Královec², R. Neuwirth¹, H. Tolaszová², O. Jiravský¹, J. Brada², J. Januška¹

¹ Oddělení kardiologie Nemocnice Podlesí a.s., Třinec, přednosta prim. MUDr. Marian Branny

² MDT - Medical Data Transfer, s.r.o, Brno, vedoucí pracovník Mgr. Veronika Bulková, Ph.D.

Aim:
The aim of the study was to compare two methods of long-term ECG monitoring after atrial fibrillation (AF) ablation.

Methods:
The study included 279 patients with paroxysmal (n = 163) or persistent (n = 116) AF, who were followed up for 1 year after the first catheter ablation for AF. All patients were provided with episodic ECG recorder for 1 year and instructed to send at least 2 random ECG recordings per day and whenever they sensed symptoms. They were also provided with external loop recorder for 2-3 weeks at 6 and 12 months to enable more continuous ECG monitoring.

Results:
At the end of 39 ± 12 (12-60) month follow-up, 143 (88%) patients with paroxysmal AF, and 105 (91%) patients with persistent AF, respectively, remained in stable sinus rhythm. The efficacy of episodic recorder expressed as a ratio of patients with identified AF/atrial tachycardia (AT) out of all patients with a documented episode of AF/AT was superior to the efficacy of loop recorder. No AF/AT episode was recorded with the loop recorder that was not also documented by the episodic recorder. Of the patients with the AF/AT recurrence detected by the episodic recorder, the arrhythmia was also revealed by the loop recorder in 70% of the patients after paroxysmal AF ablation (p < 0.001), and in 52% of the patients after persistent AF ablation (p = 0.006). Asymptomatic AF/AT was present in 42 (26%) of patients with paroxysmal AF, and in 28 (24%) patients with persistent AF (p = 0.810). From conventional follow-up unexpected and clinically significant episode of AF/AT that required change in therapy was detected in 9 (5.5%) patients after ablation for paroxysmal AF, and in 4 (3.4%) patients after ablation for persistent FS.

Conclusion:
More episodes of AF/AT after ablation were detected by 1-year daily ECG monitoring using episodic recorder as compared to periodic ECG monitoring with loop recorder. Identification of clinically significant episodes of AF/AT unrecognized from conventional follow-up was low.

Keywords: atrial fibrillation; catheter ablation; ECG monitoring

Received: March 27, 2012; Accepted: April 19, 2012; Published: September 1, 2012  Show citation