Burden-based outcomes after atrial fibrillation ablation: A 4-year continuous monitoring study.

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.