[Correction added after online publication 2-May-2013: Author name has been corrected. Dr. Frankel should be identified as David S. Frankel, M.D.]
Assessing Arrhythmia Burden After Catheter Ablation of Atrial Fibrillation Using an Implantable Loop Recorder: The ABACUS Study
Article first published online: 11 APR 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 8, pages 875–881, August 2013
How to Cite
KAPA, S., EPSTEIN, A. E., CALLANS, D. J., GARCIA, F. C., LIN, D., BALA, R., RILEY, M. P., HUTCHINSON, M. D., GERSTENFELD, E. P., TZOU, W., MARCHLINSKI, F. E., FRANKEL, D. S., COOPER, J. M., SUPPLE, G., DEO, R., VERDINO, R. J., PATEL, V. V. and DIXIT, S. (2013), Assessing Arrhythmia Burden After Catheter Ablation of Atrial Fibrillation Using an Implantable Loop Recorder: The ABACUS Study. Journal of Cardiovascular Electrophysiology, 24: 875–881. doi: 10.1111/jce.12141
The study was supported by an unrestricted grant from Medtronic, Inc., who had no role in the administration of the study, in the interpretation of data and writing of the manuscript.
A.E.E., D.J.C., R.B., M.D.H., E.P.G., F.E.M., D.F., J.M.C., R.J.C., and S.D. received honoraria from Medtronic. A.E.E., E.P.G., F.E.M., and S.D. received research support from Medtronic. M.D.H. and F.E.M. served on advisory boards for Medtronic and D.J.C. received consulting fees. Other authors: No disclosures.
- Issue published online: 22 JUL 2013
- Article first published online: 11 APR 2013
- Accepted manuscript online: 15 MAR 2013 12:00PM EST
- Manuscript Accepted: 26 FEB 2013
- Manuscript Revised: 24 FEB 2013
- Manuscript Received: 29 JAN 2013
- Medtronic, Inc.
- antiarrhythmic drugs;
- atrial fibrillation;
- catheter ablation;
- implantable loop recorder;
- pulmonary vein isolation
Assessing Arrhythmia Burden After Ablation
Arrhythmia monitoring in patients undergoing atrial fibrillation (AF) ablation is challenging. Transtelephonic monitors (TTMs) are cumbersome to use and provide limited temporal assessment. Implantable loop recorders (ILRs) may overcome these limitations. We sought to evaluate the utility of ILRs versus conventional monitoring (CM) in patients undergoing AF ablation.
Methods and Results
Forty-four patients undergoing AF ablation received ILRs and CM (30-day TTM at discharge and months 5 and 11 postablation). Over the initial 6 months, clinical decisions were made based on CM. Subjects were then randomized for the remaining 6 months to arrhythmia assessment and management by ILR versus CM. The primary endpoint was arrhythmia recurrence. The secondary endpoint was actionable clinical events (change of antiarrhythmic drugs [AADs], anticoagulation, non-AF arrhythmia events, etc.) due to either monitoring strategy.
Over the study period, 6 patients withdrew. In the first 6 months, AF recurred in 18 patients (7 noted by CM, 18 by ILR; P = 0.002). Five patients in the CM (28%) and 5 in the ILR arm (25%; P = NS) had AF recurrence during the latter 6 months. AF was falsely diagnosed frequently by ILR (730 of 1,421 episodes; 51%). In more patients in the ILR compared with the CM arm, rate control agents (60% vs 39%, P = 0.02) and AADs (71% vs 44%, P = 0.04) were discontinued.
In AF ablation patients, ILR can detect more arrhythmias than CM. However, false detection remains a challenge. With adequate oversight, ILRs may be useful in monitoring these patients after ablation.