how to monitor patients after atrial fibrillation ablation
TRANSCRIPT
How to Monitor Patients After
Atrial Fibrillation AblationWilliam Uribe Arango, MD, MBA, FHRS.SOLAECE Executive Committee (President Elect 2017-2018)Director Arrhythmias Council of SIAC 2016-2017Delegate International affairs CCEDirector Servicios de Electrofisiología CES y Centros Especializados de San Vicente Fundación (CESFV)Medellín, Colombia
SIACSociedad Interamericana de
CardiologíaCESVF
WORLD CONGRESSIN CARDIAC ELECTROPHYSIOLOGY& CARDIAC TECHNIQUES
CCE
• None
Conflict of Interest
Catheter Ablation of Atrial Fibrillation
Int J Cardiol. 2013 Oct 9;168(4)Journal of Atrial Fibrillation. 2013;6
Catheter Ablation of Atrial Fibrillation
January et al., 2014
Pitfalls
Definitions of Recurrences after PVI
Clin. Cardiol. 31, 10, 463–468 (2008)
JACC Vol. 40, No.1 (2002)
Blanking Periods
2012 HRS/EHRA/ECAS Expert consensus. Heart Rhythm
J Cardiovasc Electrophysiol, 2008;19Circ Arrhythm Electrophysiol, 2011;4
Timing of ERAT within the Blanking Period and Relationship with Late Recurrence
Heart Rhythm, 2008;5:679–85.Europace, 2009;11:1362–8
Temporal Relationship of Stroke and AF
Circulation. 2014;129Heart Rhythm. 2011;8
Circ Arrhythm Electrophysiol. 2015;8
Period (days)
Odd
s R
atio
for I
sche
mic
Str
oke
¿Why Recurrences are Important?
Am Heart J. 2006;151(3)
Monitoring Patients After AF Ablation ¿Why?
Intermittent Monitoring
Enough? Adherence Problems
Limitations of Symptom-Based Assessment
35%
36%
11%
10%7%
39%
32%4%
19%
6%
Pokushalov et al, JCE 2010
Poor Correlation between Symptoms and AF
JAMA Intern Med 2013 DISCERN AF
Sensitivity 30-40%
http://dx.doi.org/10.1016/j.pcad.2013.10.001Ambulatory ECG Monitoring in Atrial Fibrillation Management
Implanted Devices Sensitivity 96-98%
Implanted Loop Recorders Sensitivity 45-88%
Looping, non-looping event
monitorsSensitivity 39-68%
24/48-hour Holter monitoring
12-lead ECG, Transtelephonic
ECG
Sensitivity 44-60%
100%
30%Sensitivity
Mobile Cardiac Telemetry Monitors 64%
Mobile Cardiac Telemetry Monitors
J Cardiovasc Electrophysiol. March 2007
Holter 24/48 h Event Recorder
Transtelephonic ILRs-ICMs: Home Monitoring
False Positive Device-Detected Events
Circ Arrhythm Electrophysiol 2010;3Stroke. 2010;41
ASSERT. Heart Rhythm. 2012;9Heart. 2012 Mar;98(5)
J Cardiovasc Med. 2013 Feb;14(2)
Eur Heart J 2014;35:SOS AF
SOS AF PROJECT(Stroke Prevention Strategies based on Atrial Fibrillation
Information from Implanted Devices)
PACE 2015;38. Zuern C et al.
Monitoring Patients After Atrial Fibrillation Ablation, What for?
New Kardia Band for Apple Watch Delivers Medical-grade ECG Anywhere
AliveCor creates wearable medtech category
Possible Atrial
Fibrillation
This result is not a
diagnosis, only a
possible finding.
We recommend
Conclusions Continuous Monitoring after AF Ablation
Conclusion
http://www.solaece.org