Heart rhythm · 2026
Burden-based outcomes after atrial fibrillation ablation: A 4-year continuous monitoring study.
СтатьяНазвание и аннотация: Перевод в очереди
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Almorad Alexandre, El Haddad Milad, El Channan Mehdi, Blankoff Nicolas, Hossein Amin, Amin Reshma, de Waroux Jean-Benoît le Polain, Tavernier René, Duytschaever Mattias, Knecht Sébastien
Аннотация
BACKGROUND: Atrial fibrillation (AF) markedly impairs quality of life (QoL) and increases health care burden. Long-term outcomes of catheter ablation (CA) using continuous rhythm monitoring remain undercharacterized.
OBJECTIVES: The goals of this study were to assess atrial tachyarrhythmia burden (ATaB) using implantable loop recorder (ILRs) before and up to 4 years after CA and to examine the association between ATaB reduction and QoL. In an exploratory proof-of-concept analysis, we evaluated whether simulated intermittent monitoring (burden-by-sampling [BBS]) can approximate ILR-derived ATaB.
METHODS: In this single-center prospective cohort, 165 patients with paroxysmal or persistent AF underwent first-time CA after preablation ILR insertion. ATaB (percentage time in AF/atrial tachycardia) was continuously recorded for up to 4 years. Annual QoL assessments used the Short Form-36 Health Survey and an AF-specific symptom questionnaire. Retrospective BBS simulation sampled ILR data at varying frequencies to explore intermittent monitoring performance.
RESULTS: The median follow-up period was 40.9 (38.3-42.8) months. The median ATaB declined from 15% (0%-100%) to 0% (0%-22.5%) (P < .001). In the recurrence subgroup (n = 76, 46%), ATaB decreased from 93% to 0.45% (0.09%-8.2) (P < .001); >90% of patients achieved ≥75% reduction. QoL improved significantly at 1 year and remained stable, although Short Form-36 Health Survey physical health scores were not consistently significant beyond 1 year. BBS performance improved with increased sampling frequency but remained exploratory.
CONCLUSION: CA produces a durable, substantial reduction in ATaB over 4 years, with a sustained QoL benefit. These findings challenge binary definitions of ablation success and support burden-based, patient-centered end points. Exploratory BBS simulations suggest potential for intermittent monitoring but require prospective validation.
OBJECTIVES: The goals of this study were to assess atrial tachyarrhythmia burden (ATaB) using implantable loop recorder (ILRs) before and up to 4 years after CA and to examine the association between ATaB reduction and QoL. In an exploratory proof-of-concept analysis, we evaluated whether simulated intermittent monitoring (burden-by-sampling [BBS]) can approximate ILR-derived ATaB.
METHODS: In this single-center prospective cohort, 165 patients with paroxysmal or persistent AF underwent first-time CA after preablation ILR insertion. ATaB (percentage time in AF/atrial tachycardia) was continuously recorded for up to 4 years. Annual QoL assessments used the Short Form-36 Health Survey and an AF-specific symptom questionnaire. Retrospective BBS simulation sampled ILR data at varying frequencies to explore intermittent monitoring performance.
RESULTS: The median follow-up period was 40.9 (38.3-42.8) months. The median ATaB declined from 15% (0%-100%) to 0% (0%-22.5%) (P < .001). In the recurrence subgroup (n = 76, 46%), ATaB decreased from 93% to 0.45% (0.09%-8.2) (P < .001); >90% of patients achieved ≥75% reduction. QoL improved significantly at 1 year and remained stable, although Short Form-36 Health Survey physical health scores were not consistently significant beyond 1 year. BBS performance improved with increased sampling frequency but remained exploratory.
CONCLUSION: CA produces a durable, substantial reduction in ATaB over 4 years, with a sustained QoL benefit. These findings challenge binary definitions of ablation success and support burden-based, patient-centered end points. Exploratory BBS simulations suggest potential for intermittent monitoring but require prospective validation.