Impact of follow-up strategy after catheter ablation of atrial fibrillation on repeat procedures
C Isenegger, J Bruegger, F Jordan, A Bettelini, C Moser, S Knecht, P Krisai, D Spreen, N Schaerli, R Stump, B Schaer, F Mahfoud, C Sticherling, M Kuehne, P BadertscherAbstract
Introduction
The intensity and type of rhythm monitoring after catheter ablation for atrial fibrillation (AF) affects arrhythmia detection. However, it is unclear whether more intensive rhythm surveillance also translates into higher rates of repeat ablation.
Purpose
To compare the impact of systematic Holter ECG follow-up versus implantable loop recorder (ILR) monitoring on the incidence of repeat catheter ablation procedures after first-time pulmonary vein isolation (PVI).
Methods
Patients with paroxysmal AF undergoing single-shot PVI at a tertiary center were enrolled prospectively. Follow-up consisted of standardized Holter recordings at 3, 6, and 12 months (plus symptom-triggered ECGs) or continuous ILR monitoring. Recurrence was defined as any atrial arrhythmia lasting >30 seconds after a 60-day blanking period. Redo procedures performed within 3 years after index PVI were analyzed. Cohorts were propensity-score matched for age, sex, AF type, and cardiovascular comorbidities.
Results
A total of 240 patients (median age 64 [56–71] years, 25% female) were included; 120 (50%) underwent Holter-based follow-up and 120 (50%) ILR-based follow-up. Ablation modality was similar (Cryo 75% vs. 79%; pulsed-field ablation 25% vs. 21%; p = 0.443). At 1-year, atrial arrhythmia recurrence was significantly more frequently detected in ILR patients compared to Holter (41% vs. 25%; log-rank p = 0.006). Redo procedures were performed in 20% vs. 15% of ILR vs. Holter, respectively (p = 0.308). Median time to redo was comparable (455 vs. 427 days; p = 0.458), and redo-free survival did not differ (log-rank p = 0.196). Results were consistent across ablation modalities.
Conclusion
Despite markedly higher arrhythmia detection with continuous rhythm monitoring, follow-up modality did not significantly impact redo rates after PVI. These data suggest that more intensive follow-up using ILRs does not necessarily alter clinical decision-making regarding repeat ablation.