Abstract 1737: A Strategy for Continuous ECG Recording in Patients Post Pulmonary Vein Isolation for Atrial Fibrillation
Introduction: Following pulmonary vein isolation (PVI) for management of atrial fibrillation (AF), may centers obtain continuous ECG recordings for several weeks in order to detect early recurrences of AF. However, the implications of early AF following PVI in an individual patient are unknown as is the optimal duration of monitoring in these patients.
Methods: We evaluated 72 pts (60 ± 11 yrs, 67% male, 67% paroxysmal AF) who underwent PVI and were followed for >= 6 months. At hospital discharge, all pts were fitted with an external event loop recorder (LifeWatch AF Express) for 14 weeks for the continuous automatic detection of AF (defined as an episode lasting >= 30 sec). Clinical follow-up occurred at 1, 3 and 6 months post-PVI; procedural success was defined by freedom from AF at the 6 month follow-up.
Results: During the 14-week loop monitoring period, no AF was observed in 25 (35%) patients. Only 2 of these pts subsequently developed AF; in both cases, AF occurred 3– 6 months post-PVI. In contrast, 47 (65%) patients had at least 1 AF episode, most commonly (39/47 pts, 83%) within the first 2 weeks of PVI. In fact, absence of AF during the first 2-weeks of loop monitoring identified a cohort of patients with high likelihood of procedural success at 6 months (Figure⇓).
Conclusions: Our data support a rationale for at least 2-weeks of continuous automatic loop ECG monitoring in all pts post-PVI. Patients without AF during this period can be expected to have excellent long-term outcome. Longer periods of ECG monitoring may be better limited to patients in whom AF is observed during initial 2-week monitoring.