European Heart Journal Advance Access originally published online on February 9, 2008
European Heart Journal 2008 29(8):1037-1042; doi:10.1093/eurheartj/ehn024
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What is the real atrial fibrillation burden after catheter ablation of atrial fibrillation? A prospective rhythm analysis in pacemaker patients with continuous atrial monitoring
Department of Cardiology, University Heart Centre Hamburg, Martinistr. 52, Hamburg 20246, Germany
Received 11 August 2007; revised 7 January 2008; accepted 10 January 2008; online publish-ahead-of-print 9 February 2008.
* Corresponding author. Tel: +49(0) 40 42803 4120, Fax: +49(0) 40 42803 4125, Email: d.steven{at}uke.uni-hamburg.de
See page 964 for the editorial comment on this article (doi:10.1093/eurheartj/ehn108)
Aims: Rhythm follow-up after catheter ablation of atrial fibrillation (AF ablation) is mainly based on Holter electrocardiogramm (ECG), tele-ECG or on patients symptoms. However, studies using 7-day Holter or tele-ECG follow-up revealed a significant number of asymptomatic recurrences. Thus, the aim of this study was to analyse continuous atrial recordings in pacemaker patients with an incorporated Holter function before and after AF ablation in order to determine all AF recurrences and thereby the ‘real’ success rates.
Methods and results: The study comprised 37 patients (64.6 ± 10 years) with prior pacemaker/implantable cardioverter defibrillator (ICD) implantation including an atrial Holter function referred for AF ablation. Holter data were obtained and correlated to patients’ symptoms before and every 3-month after AF ablation. AF recurrence was defined as an atrial high frequency episode of less than 330 ms (180 b.p.m.) lasting longer than 30 s. The ablation procedure consisted of pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF, n = 20) and additional substrate modification aiming arrhythmia termination in patients with persistent or inducible AF after PVI as well as in patients with a history of long-lasting persistent AF (PersAF, n = 17). The mean atrial Holter monitoring period was 7.4 ± 3.3 months before and 13.5 ± 4.2 months after ablation with an overall AF burden of 33.7% prior to ablation. During follow-up, AF burden decreased from 17.3–0.65% (P = 0.001) in PAF patients and from 57.4 to 13.9% (P = 0.024) in patients with PersAF. Complete AF freedom was observed in 85% (17 patients) of PAF patients and 59% (10 patients) in patients with PersAF. The absence of symptoms correlated well with documented freedom of AF.
Conclusion: In the present study we could show, that freedom from AF can be achieved by catheter ablation in a high percentage of patients even with PersAF. Continuous atrial monitoring reveals AF ablation success rates comparable with those assessed by clinical evaluation. Symptomatic freedom of AF correlated well with the actual freedom of AF at least in this highly symptomatic patient cohort.
Key Words: Atrial fibrillation • Ablation • Pacemaker • Atrial Holter recording
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  C. Martignani, I. Diemberger, M. Biffi, C. Valzania, M. Bertini, and G. Boriani How to assess the efficacy of catheter ablation of atrial fibrillation? Eur. Heart J., September 1, 2008; 29(17): 2183 - 2184. [Full Text] [PDF]
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D. Steven and S. Willems How to assess the efficacy of catheter ablation of atrial fibrillation: reply Eur. Heart J., September 1, 2008; 29(17): 2184 - 2185. [Full Text] [PDF]
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D. Shah Atrial fibrillation burden: a 'hard' indicator of therapeutic efficacy and a prognostic marker to boot? Eur. Heart J., April 2, 2008; 29(8): 964 - 965. [Full Text] [PDF]
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