Atrial Fibrillation Ablation Success Defined by Duration of Recurrence
on Cardiac Implantable Electronic Devices
Abstract
Background: Ablation for atrial fibrillation (AF) has emerged as an
effective method of rhythm control. This exploratory analysis aimed to
determine how various measures of recurrence would influence the
definition of treatment success. Methods: Using an EHR dataset from
01/2007-06/2019 linked with Medtronic cardiac implantable electronic
device (CIED) data, patients who underwent a first AF ablation procedure
following CIED implantation were identified. Data were analyzed for
recurrence of AF stratified by varying definitions of successful
ablation. Performance of various simulated external AF monitoring
strategies was assessed. Results: A total of 665 patients were analyzed
including 248 with paroxysmal AF (mean age 66.2±9.3 years, 73.0% male)
and 417 patients with persistent AF (mean age 67.3±9.0 years, 73.6%
male). Patients with paroxysmal AF, survival free from recurrence at 1
year ranged from 28.2% to 72.1% (>6 min and
>23 hours thresholds, respectively) with an overall median
percentage of time in AF reduction of 99.6%. Patients with persistent
AF, survival free from recurrence at 1 year ranged from 24.9% to 60.0%
(>6 min and 7 consecutive days >23 hours
thresholds, respectively) with an overall median percentage of time in
AF reduction of 99.3%. A single 7-day monitoring strategy had a
sensitivity of < 50% for detecting AF > 6 min in
patients with paroxysmal and persistent AF. Conclusion: In this
real-world dataset of AF patients with CIEDs undergoing catheter
ablation, treatment success varied substantially with different
definitions of minimally required AF duration and is significantly
impacted by the method of recurrence detection.