Heart Rhythm O2 (Jun 2021)

Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation

  • Gary Peng, MD, PhD,
  • Aung N. Lin, MD,
  • Edmond Obeng-Gyimah, MD,
  • Samantha N. Hall,
  • Ya-wen Yang, MD,
  • Shiquan Chen, MD,
  • Michael Riley, MD, PhD,
  • Rajat Deo, MD, MTR,
  • Aasima Ali, PA,
  • Jeffery Arkles, MD, FHRS,
  • Andrew E. Epstein, MD, FHRS,
  • Sanjay Dixit, MD, FHRS

Journal volume & issue
Vol. 2, no. 3
pp. 255 – 261

Abstract

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Background: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives: To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population. Methods: Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation. Results: A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7–17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23–72) in the CM group (P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation. Conclusion: Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population.

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