Björkenheim Anna, Brandes Axel, Chemnitz Alexander, Magnuson Anders, Edvardsson Nils, Poçi Dritan
Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Pacing Clin Electrophysiol. 2016 Sep;39(9):914-25. doi: 10.1111/pace.12916. Epub 2016 Aug 5.
URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.
To evaluate rhythm control up to two years after atrial fibrillation (AF) ablation and its relation to reported symptoms.
The implantable loop recorder (ILR) continuously records the electrocardiogram (ECG), has an automatic AF detection algorithm, and has a possibility for patients to activate an ECG recording during symptoms.
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.
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% (interquartile range 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 AF episode >6 hours before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.
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.
网址：http://clinicaltrials.gov。唯一标识符：NCT00697359。
评估心房颤动（AF）消融术后长达两年的节律控制及其与所报告症状的关系。
植入式环路记录仪（ILR）可连续记录心电图（ECG），具有自动房颤检测算法，患者有可能在出现症状时激活心电图记录。
57例患者（平均年龄57±9岁，60%为男性，88%为阵发性房颤）在植入ILR后接受了房颤消融术。在消融时以及消融后3、6、12、18和24个月下载设备数据。
54例患者完成了两年随访。13例（24%）患者在随访期间ILR未检测到房颤发作。41例房颤复发患者中有10例（24%）仅被ILR检测到，且ILR更早检测到房颤复发（P<0.001）。房颤复发患者的房颤负荷中位数为5.7%（四分位间距0.4 - 14.4），仅被ILR检测到房颤的患者房颤负荷更低（P = 0.001）。48%的患者通过患者激活器提示有症状，但这些记录中有33%并非由房颤引起。早期房颤复发（3个月内）与后期房颤复发高度相关（P<0.001）。消融前房颤负荷>0.5%以及最长房颤发作>6小时是间歇性而非连续性监测期间房颤复发的独立预测因素。
房颤消融术后，在24个月的随访期间房颤负荷较低。然而，症状通常有提示，但三分之一的患者激活记录未显示房颤。在检测房颤发作和评估房颤负荷方面，连续监测优于间歇性随访。
