How to Monitor Patients After

Atrial Fibrillation AblationWilliam Uribe Arango, MD, MBA, FHRS.SOLAECE Executive Committee (President Elect 2017-2018)Director Arrhythmias Council of SIAC 2016-2017Delegate International affairs CCEDirector Servicios de Electrofisiología CES y Centros Especializados de San Vicente Fundación (CESFV)Medellín, Colombia

SIACSociedad Interamericana de

CardiologíaCESVF

WORLD CONGRESSIN CARDIAC ELECTROPHYSIOLOGY& CARDIAC TECHNIQUES

CCE

• None

Conflict of Interest

Catheter Ablation of Atrial Fibrillation

Int J Cardiol. 2013 Oct 9;168(4)Journal of Atrial Fibrillation. 2013;6

Catheter Ablation of Atrial Fibrillation

January et al., 2014

Pitfalls

Definitions of Recurrences after PVI

Clin. Cardiol. 31, 10, 463–468 (2008)

JACC Vol. 40, No.1 (2002)

Blanking Periods

2012 HRS/EHRA/ECAS Expert consensus. Heart Rhythm

J Cardiovasc Electrophysiol, 2008;19Circ Arrhythm Electrophysiol, 2011;4

Timing of ERAT within the Blanking Period and Relationship with Late Recurrence

Heart Rhythm, 2008;5:679–85.Europace, 2009;11:1362–8

Temporal Relationship of Stroke and AF

Circulation. 2014;129Heart Rhythm. 2011;8

Circ Arrhythm Electrophysiol. 2015;8

Period (days)

Odd

s R

atio

for I

sche

mic

Str

oke

¿Why Recurrences are Important?

Am Heart J. 2006;151(3)

Monitoring Patients After AF Ablation ¿Why?

Intermittent Monitoring

Enough? Adherence Problems

Limitations of Symptom-Based Assessment

35%

36%

11%

10%7%

39%

32%4%

19%

6%

Pokushalov et al, JCE 2010

Poor Correlation between Symptoms and AF

JAMA Intern Med 2013 DISCERN AF

Sensitivity 30-40%

http://dx.doi.org/10.1016/j.pcad.2013.10.001Ambulatory ECG Monitoring in Atrial Fibrillation Management

Implanted Devices Sensitivity 96-98%

Implanted Loop Recorders Sensitivity 45-88%

Looping, non-looping event

monitorsSensitivity 39-68%

24/48-hour Holter monitoring

12-lead ECG, Transtelephonic

ECG

Sensitivity 44-60%

100%

30%Sensitivity

Mobile Cardiac Telemetry Monitors 64%

Mobile Cardiac Telemetry Monitors

J Cardiovasc Electrophysiol. March 2007

Holter 24/48 h Event Recorder

Transtelephonic ILRs-ICMs: Home Monitoring

False Positive Device-Detected Events

Circ Arrhythm Electrophysiol 2010;3Stroke. 2010;41

ASSERT. Heart Rhythm. 2012;9Heart. 2012 Mar;98(5)

J Cardiovasc Med. 2013 Feb;14(2)

Eur Heart J 2014;35:SOS AF

SOS AF PROJECT(Stroke Prevention Strategies based on Atrial Fibrillation

Information from Implanted Devices)

PACE 2015;38. Zuern C et al.

Monitoring Patients After Atrial Fibrillation Ablation, What for?

New Kardia Band for Apple Watch Delivers Medical-grade ECG Anywhere

AliveCor creates wearable medtech category

Possible Atrial

Fibrillation

This result is not a

diagnosis, only a

possible finding.

We recommend

Conclusions Continuous Monitoring after AF Ablation

Conclusion

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