Arrhythmia Institute, Valley Health System, The Valley Hospital, Ridgewood, New Jersey; Columbia University College of Physicians and Surgeons, New York, New York,.
Heart Rhythm. 2013 Nov;10(11):1598-604. doi: 10.1016/j.hrthm.2013.07.044. Epub 2013 Jul 30.
In patients with atrial flutter who undergo cavotricuspid isthmus ablation, long-term electrocardiographic (ECG) monitoring may identify new onset of atrial fibrillation (AF).
To ascertain, through the use of an implantable loop recorder (ILR) with a dedicated AF detection algorithm, the incidence, duration, and burden of new AF in these patients and to develop an optimal postablation ECG monitoring strategy.
We enrolled 20 patients with flutter, a CHADS2 score of 2-3, and no prior episode of AF. After cavotricuspid isthmus ablation, we implanted an ILR, which was interrogated routinely; all stored ECGs were adjudicated.
During a mean follow-up of 382 ± 218 days, 3 patterns were observed. First, in 11 (55%) patients, stored ECGs confirmed AF at 62 ± 38 days after ablation. Second, in 4 (20%) patients, although the ILR suggested AF, episodes actually represented sinus rhythm with frequent premature atrial contractions and/or oversensing. Third, in 5 (25%) patients, no AF was observed. Episodes <4 hours were associated with low AF burden (<1%) or false detections. The 1-year freedom from any episode of AF >4 and >12 hours was 52% and 83%, respectively.
Our data show that many (but not all) patients develop new AF within the first 4 months of flutter ablation. Since external ECG monitoring for this duration is impractical, the ILR has an important role for long-term AF surveillance. Future research should be directed toward identifying the relationship between duration/burden of AF and stroke and improving existing ILR technology.
在接受峡部消融术的房扑患者中，长期心电图（ECG）监测可能会发现新发房颤（AF）。
通过使用带有专用 AF 检测算法的植入式环路记录器（ILR），确定这些患者中新发 AF 的发生率、持续时间和负担，并制定最佳的消融后 ECG 监测策略。
我们纳入了 20 例伴有房扑、CHADS2 评分 2-3 分且无 AF 病史的患者。在完成峡部消融术后，我们植入了 ILR，常规进行了 ILR 检测；所有存储的 ECG 均进行了判定。
在平均 382±218 天的随访中，观察到 3 种模式。首先，在 11 例（55%）患者中，存储的 ECG 在消融后 62±38 天证实 AF。其次，在 4 例（20%）患者中，尽管 ILR 提示 AF，但实际上是窦性心律伴频发房性期前收缩和/或过感知。第三，在 5 例（25%）患者中，未观察到 AF。<4 小时的发作与低 AF 负担（<1%）或假阳性检测相关。1 年时无任何>4 小时和>12 小时的 AF 发作的概率分别为 52%和 83%。
我们的数据表明，许多（但不是所有）患者在房扑消融后的头 4 个月内会新发 AF。由于在此期间进行外部 ECG 监测不切实际，因此 ILR 在长期 AF 监测中具有重要作用。未来的研究应致力于确定 AF 持续时间/负担与中风之间的关系，并改进现有的 ILR 技术。
