The Role Of Long-term Electrocardiogram Monitoring Devices In Screening Atrial Fibrillation After Radiofrequency Catheter Ablation

BackgroundAtrial fibrillation (AF) is one of the most common cardiac arrhythmias in clinical practice. And with the aging of the population, the morbidity of atrial fibrillation is increasing year by year. Ischemic stroke is one of the most important clinical complications of atrial fibrillation, which could significantly reduce the quality of life and at the same time increase the mortality of atrial fibrillation. Radiofrequency catheter ablation (RFCA) is now the major therapy for atrial fibrillation, especially in the patients with significant symptoms but failed to response to anti-arrhythmia drugs. However, there are still 30%-40% patients under RFCA would experience a recurrence of atrial fibrillation and need to take anti-arrhythmia drugs or undergoing RFCA again.24h-Holter is the routine way to screen recurrence of atrial fibrillation after RFCA. But due to the limited monitor time, the incidence of atrial fibrillation recurrence detected by 24h-Holter is quite low. And there is still no conclusion about the optimal duration of the long-term monitor to screen atrial fibrillation after RFCA. In addition, some studies pointed that early atrial fibrillation (EAF) or early atrial tachycardia (CAT) after RFCA was one independent risk factor for late atrial fibrillation (LAF), while the impact of EAF or EAT occurs in different periods of time on LAF is still not clear.ObjectionIn our study, we used the long-term (7-day) electrocardiogram monitoring devices to investigate:1) the incidences of EAF and EAT within 7 days after RFCA in atrial fibrillation patients; 2) the relationship between atrial fibrillation related symptoms and atrial fibrillation recurrence within 7 days after RFCA; 3) the risk factors of EAF or EAT within 7 days after RFCA; 4) the optimal duration to screen EAF or EAT after RFCA in atrial fibrillation patients; 5) to compare the difference of stability between 2 different monitor devices.MethodIn this study, we included 20 patients with atrial fibrillation underwent circumferential pulmonary vein isolation (CIPV) in the cardiology department of Peking Union Medical College Hospital (PUMCH) from 2016/03/01 to 2016/05/31. Before RFCA, we recorded the gender, age, body mass index (BMI), type of atrial fibrillation, with or without atrial flutter, other accompanied disorders, medication history, creatinine, NT-proBNP, left atrial diameter (LAD) and left ventricular ejection fraction (LVEF). After RFCA, the patients equipped with the long-term monitors for 7 days. After 7 days, the patients returned the devices and we exported the date to the computer to analysis the incidence of EAF/EAT, the first time EAF/EAT recorded and the burden of atrial fibrillation.Result1. The incidence of EAF within 7 days after RFCA was 30% and the incidence of EAT was 20%. The incidence of EAF/EAT within 7 days after RFCA was 45%.2. In the patients who had the atrial fibrillation related symptoms (e.g. palpitation, dizziness), only 33.3% were detected to have EAF and 11.1% were detected to have EAT. While in the patients without atrial fibrillation related symptoms,27.3% had EAF and 18.2% had EAT in addition.3. LVEF was the risk factor of EAF. Gender, age, BMI, type of atrial fibrillation, with or without atrial flutter, duration of atrial fibrillation, other accompanied disorders, smoking or LAD were not the independent risk factor for EAF within 7 days after atrial fibrillation ablation.4. Within 7 days after RFCA,9 patients were detected to have EAF or EAT. Among these patients, only 2 patient were detected within 24 hours after ablation,7 patients were detected within 3 days, one patient was detected on day 5 and one was detected on day 7. By using Fisher exact test, we found that there was no significant difference in the incidence of EAF/EAT between 5 days and 7 days (p>0.05).5. The atrial fibrillation burden of patients who detected EAF within 3 days after RFCA was more than 20% and more than 10% with 5 days. The atrial fibrillation burden of patients detected EAF on day 7 was less than 10%.6. The percentage of efficiency monitor hours of Xinweishi of Beijing Ouqiao company was 80.5±21.5%, while the Tiexin of Shanghai Yueguang company was 91.0±12.0%. There was no significant difference between these 2 devices (p>0.05).Conclusion1. The incidence of EAF/EAT after RFCA for atrial fibrillation is high.2. There was no clear relationship between clinical symptoms and atrial fibrillation recurrence.3. LVEF was the risk factor of EAF after RFCA. Gender, age, BMI, duration of atrial fibrillation, other accompanied disease, smoking or LAD were not the independent risk factors of EAF within 7 days after RFCA.4. Within 3 days, prolong the duration of the monitor could increase the detection rate of EAF/EAT. While after 3 days, prolong the duration could not significant increase the detection rate.5. The higher the atrial fibrillation burden, the earlier the EAF detected.6. There was no significant difference between 2 long-term monitors in our study.