Value of Different Follow‐Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial Fibrillation

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Abstract
Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7‐day Holter as two methods of follow‐up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow‐up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow‐up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow‐up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7‐day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan‐Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow‐up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7‐day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30–40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom‐only‐based follow‐up; using serial 7‐day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7‐day Holter were equally effective to objectively determine long‐term success and to detect asymptomatic patients.