A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence: Insights from 647 Continuously Monitored Patients and Implications for Monitoring After Therapeutic Interventions
Background—Intermittent rhythm monitoring (IRM) to detect atrial fibrillation (AF) recurrence is employed to evaluate the success of therapeutic interventions. In a large population of continuously monitored (CM) patients, we investigated the sensitivity of various frequency and duration IRM strategies on the detection of AF recurrence, the dynamics behind AF recurrence detection and describe measures to evaluate temporal AF recurrence.
Methods and Results—Rhythm histories of 647 patients (mean AF burden: 0.12±0.22; median: 0.014; 687 patient*years) with implantable CM devices were reconstructed and analyzed. Using computationally intensive simulation, the sensitivity of IRM of various frequencies and durations on the identification of AF recurrence was evaluated. Prolonged duration IRM was superior to shorter IRM (p<0.0001). However, even with aggressive IRM strategies, AF recurrence was not detected in a great proportion of patients. The temporal AF burden aggregation (AF density) was directly related to IRM sensitivity (p<0.0001). Even at similar AF burdens, patients with high density AF required higher frequency or prolonged duration IRM to achieve the same sensitivity as in low density AF (p<0.0001). Patients with high density, low burden AF benefit the most from CM for detection of AF recurrence.
Conclusions—IRM follow up is significantly inferior to CM. IRM strategies will not identify AF recurrence in a great proportion of patients at risk. Temporal AF characteristics play a significant role in AF recurrence detection using IRM. For the scientific, evidence based evaluation of AF treatments, CM should be strongly recommended. Prospective studies are required to evaluate if CM to guide clinical management can also improve patient outcomes.
Clinical Trial Registration Information—clinicaltrials.gov; Identifier: NCT00806689.
- Received February 8, 2012.
- Accepted June 14, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited