Symptomatic and silent atrial fibrillation recurrences after PVI ablation – usefulness of prolonged 7-day Holter recordings. One-center observation

Introduction

Atrial fibrillation (AF), especially its paroxysmal form (paroxysmal atrial fibrillation – PAF), is still the most common arrhythmia observed in cardiological practice. It is well known that some diseases may predispose patients to PAF occurrence – such as hypertension, coronary artery disease, valvular heart disease, congestive heart failure, pericarditis, thyrotoxic heart disease, sinus node disease, but also hypokalemia and alcohol overconsumption. However, especially in younger individuals, arrhythmia may occur without any evidenced disease or reason. It should be emphasized that up to 30–40% of episodes are completely asymptomatic (silent atrial fibrillation), and there are some data indicating that this form of PAF is especially often observed in patients after ablation procedures. Cardiac denervation caused by ablation is probably responsible for this phenomenon. These observations seem to be very important, because catheter ablation, according to the latest European Society of Cardiology (ESC) guidelines, has become a preferable and commonly used method of treatment, especially in young and highly symptomatic patients with drug refractory arrhythmia [1]. Some different ablation strategies were proposed, but pulmonary vein isolation (PVI) is a cornerstone of AF ablation, nowadays. Unfortunately, reconnections of PV-atrium junctions and/or non-pulmonary localization of AF trigger may be responsible for limitation of the ablation success rate. Absolute effectiveness of PVI in patients with PAF is still not well known because studies based on the follow-up using only the clinical symptoms have a limited value [2, 3]. More precise data might be obtained with the use of long-term continuous ECG recordings, e.g. several-day Holter recordings or tele-ECG methods. Therefore, the purpose of this study was to compare results obtained from 1-day and continuous 7-day Holter recordings performed in patients with PAF in regard to relapses of arrhythmia after PVI.

Aim

We estimated the presence of PAF and the correlation between symptoms and arrhythmia recurrences.

Material and methods

We prospectively observed 102 highly symptomatic patients with drug-refractory PAF (at least 2–3 antiarrhythmic agents were used in history) or with intolerance of antiarrhythmic drugs, qualified for PVI in the years 2014–2016. All of these patients were treated by radiofrequency point-by-point circumferential pulmonary vein ablation....


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