Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation
Background: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives: To...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Heart Rhythm O2 |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821000829 |
| _version_ | 1818589123707928576 |
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| author | Gary Peng, MD, PhD Aung N. Lin, MD Edmond Obeng-Gyimah, MD Samantha N. Hall Ya-wen Yang, MD Shiquan Chen, MD Michael Riley, MD, PhD Rajat Deo, MD, MTR Aasima Ali, PA Jeffery Arkles, MD, FHRS Andrew E. Epstein, MD, FHRS Sanjay Dixit, MD, FHRS |
| author_facet | Gary Peng, MD, PhD Aung N. Lin, MD Edmond Obeng-Gyimah, MD Samantha N. Hall Ya-wen Yang, MD Shiquan Chen, MD Michael Riley, MD, PhD Rajat Deo, MD, MTR Aasima Ali, PA Jeffery Arkles, MD, FHRS Andrew E. Epstein, MD, FHRS Sanjay Dixit, MD, FHRS |
| author_sort | Gary Peng, MD, PhD |
| collection | DOAJ |
| description | Background: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives: To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population. Methods: Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation. Results: A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7–17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23–72) in the CM group (P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation. Conclusion: Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population. |
| first_indexed | 2024-12-16T09:35:39Z |
| format | Article |
| id | doaj.art-500308795df84475b171d1c9e62404e0 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-16T09:35:39Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-500308795df84475b171d1c9e62404e02022-12-21T22:36:24ZengElsevierHeart Rhythm O22666-50182021-06-0123255261Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablationGary Peng, MD, PhD0Aung N. Lin, MD1Edmond Obeng-Gyimah, MD2Samantha N. Hall3Ya-wen Yang, MD4Shiquan Chen, MD5Michael Riley, MD, PhD6Rajat Deo, MD, MTR7Aasima Ali, PA8Jeffery Arkles, MD, FHRS9Andrew E. Epstein, MD, FHRS10Sanjay Dixit, MD, FHRS11Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaElectrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaAddress reprint requests and correspondence: Dr Sanjay Dixit, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104.; Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PennsylvaniaBackground: Patients with typical atrial flutter (AFL) undergoing successful cavotricuspid isthmus ablation remain at risk for future development of new-onset atrial fibrillation (AF). Conventional monitoring (CM) techniques have shown AF incidence rates of 18%–50% in these patients. Objectives: To evaluate whether continuous monitoring using implantable loop recorders (ILRs) would enhance AF detection in this patient population. Methods: Veteran patients undergoing AFL ablation between 2002 and 2019 who completed at least 6 months of follow-up after the ablation procedure were included. We compared new-onset AF detection between those who underwent CM and those who received ILRs immediately following AFL ablation. Results: A total of 217 patients (age: 66 ± 9 years; all male) participated. CM was used in 172 (79%) and ILR in 45 (21%) patients. Median follow-up duration after ablation was 4.1 years. Seventy-nine patients (36%) developed new-onset AF, which was detected by CM in 51 and ILR in 28 (30% vs 62%, respectively, P < .001). AF detection occurred at 7.7 months (IQR: 4.7–17.5) after AFL ablation in the ILR group vs 41 months (IQR: 23–72) in the CM group (P < .001). Eleven patients (5%) experienced cerebrovascular events (all in the CM group) and only 4 of these patients (36%) were on long-term anticoagulation. Conclusion: Patients undergoing AFL ablation remain at an increased risk of developing new-onset AF, which is detected sooner and more frequently by ILR than by CM. Improving AF detection may allow optimization of rhythm management strategies and anticoagulation in this patient population.http://www.sciencedirect.com/science/article/pii/S2666501821000829Arrhythmia detection and monitoringCTI-dependent atrial flutterImplantable loop recorderNew-onset atrial fibrillationTypical atrial flutter |
| spellingShingle | Gary Peng, MD, PhD Aung N. Lin, MD Edmond Obeng-Gyimah, MD Samantha N. Hall Ya-wen Yang, MD Shiquan Chen, MD Michael Riley, MD, PhD Rajat Deo, MD, MTR Aasima Ali, PA Jeffery Arkles, MD, FHRS Andrew E. Epstein, MD, FHRS Sanjay Dixit, MD, FHRS Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation Heart Rhythm O2 Arrhythmia detection and monitoring CTI-dependent atrial flutter Implantable loop recorder New-onset atrial fibrillation Typical atrial flutter |
| title | Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation |
| title_full | Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation |
| title_fullStr | Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation |
| title_full_unstemmed | Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation |
| title_short | Implantable loop recorder for augmenting detection of new-onset atrial fibrillation after typical atrial flutter ablation |
| title_sort | implantable loop recorder for augmenting detection of new onset atrial fibrillation after typical atrial flutter ablation |
| topic | Arrhythmia detection and monitoring CTI-dependent atrial flutter Implantable loop recorder New-onset atrial fibrillation Typical atrial flutter |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821000829 |
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