Foti Rosario, Di Silvestro Michele, Campisi Giuseppe, Conti Sergio, Picciolo Giuseppe, Cardì Carlo, Barbanti Marco, Rapisarda Giulia, Parlavecchio Antonio, Sgarito Giuseppe
PO San Vincenzo, Azienda Sanitaria Provinciale Messina, 98123 Messina, Italy.
PO Umberto I, Azienda Sanitaria Provinciale Enna, 94100 Enna, Italy.
J Clin Med. 2025 Apr 24;14(9):2932. doi: 10.3390/jcm14092932.
: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring with implantable loop recorders (ILRs) enhanced by artificial intelligence (AI) can detect both symptomatic and asymptomatic episodes, potentially optimizing patient management. This analysis assessed the long-term effectiveness of CBA in maintaining sinus rhythm and investigated the role of ILR-guided monitoring in enhancing therapeutic decisions. : Data from 91 patients with paroxysmal or persistent atrial fibrillation (AF) who underwent pulmonary vein isolation using cryoballoon ablation at four Italian centers between April 2022 and April 2024 were analyzed. All patients received an insertable loop recorder (ILR) before or during hospitalization for ablation, allowing for the continuous remote monitoring of arrhythmias. Baseline demographics, procedural details, AF occurrence, AF burden (calculated as the total duration of all AF episodes occurring within a day and categorized by episode duration), therapeutic adjustments, and the effect of artificial intelligence (AI) on data processing were evaluated. : The cohort's average age was 62.4 years, with 24.2% of participants being female. Physician-confirmed AF recurrence was noted in 26.7% of patients at 12 months and 49.5% at 24 months. The device data indicated a daily AF burden of ≥6 min in 47.2% at 12 months, with 25.9% surpassing 1 h. AI algorithms decreased false-positive alerts by 21%, resulting in an estimated saving of 19 clinician hours. In patients with pre-ablation ILR data, the median AF burden significantly decreased from 7% to 0.2% ( = 0.017). ILR-guided monitoring affected treatment adjustments, leading to the discontinuation of antiarrhythmic therapy in 36 patients and redo ablations in 8. : Continuous ILR monitoring, combined with AI-driven analysis, enables the detection of AF recurrences and burden, thereby facilitating timely therapeutic adjustments.
心房颤动（AF）是与中风、心力衰竭及死亡率增加相关的最常见持续性心律失常。由于其有效性和安全性，冷冻球囊消融术（CBA）在节律控制方面被广泛接受；然而，房颤的长期复发仍是一项挑战。通过人工智能（AI）增强的植入式环路记录器（ILR）进行持续监测，可检测有症状和无症状发作，有可能优化患者管理。本分析评估了CBA在维持窦性心律方面的长期有效性，并研究了ILR引导监测在加强治疗决策中的作用。
分析了2022年4月至2024年4月期间在意大利四个中心接受冷冻球囊消融肺静脉隔离术的91例阵发性或持续性心房颤动（AF）患者的数据。所有患者在住院消融前或消融期间均接受了插入式环路记录器（ILR），以便对心律失常进行持续远程监测。评估了基线人口统计学特征、手术细节、房颤发生情况、房颤负荷（计算为一天内发生的所有房颤发作的总持续时间，并按发作持续时间分类）、治疗调整以及人工智能（AI）对数据处理的影响。
该队列的平均年龄为62.4岁，24.2%的参与者为女性。医生确认的房颤复发率在12个月时为26.7%，24个月时为49.5%。设备数据显示，12个月时47.2%的患者每日房颤负荷≥6分钟，25.9%的患者超过1小时。人工智能算法将假阳性警报减少了21%，估计节省了19个临床医生工时。在有消融前ILR数据的患者中，房颤负荷中位数从7%显著降至0.2%（P = 0.017）。ILR引导监测影响了治疗调整，导致36例患者停用抗心律失常治疗，8例患者再次消融。
持续的ILR监测与人工智能驱动的分析相结合，能够检测房颤复发和负荷，从而促进及时的治疗调整。
