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CLINICAL RESEARCH: ABLATION OF ATRIAL FIBRILLATION

Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation

Gaetano Senatore, MD^*,*, Giuseppe Stabile, MD, Emanuele Bertaglia, MD, Giovanni Donnici, MD^*, Antonio De Simone, MD, Franco Zoppo, MD, Pietro Turco, MD, Pietro Pascotto, MD and Massimo Fazzari, MD^*

^* Divisione di Cardiologia, Ospedale Civile di Cirie' (TO), Cirie', Italy
Laboratorio di Elettrofisiologia ed Elettrostimolazione, Casa di Cura San Michele, Maddaloni, Italy
Dipartimento di Cardiologia, Ospedale Civile di Mirano, Mirano, Italy

Manuscript received September 26, 2004; accepted November 22, 2004.

^* Reprint requests and correspondence: Dr. Gaetano Senatore, Divisione di Cardiologia, Ospedale di Cirie' (TO), Via Battitore 7, 10073 Cirie' (TO), Italy (Email: senatoreg{at}libero.it).

OBJECTIVES: The aim of our study was to determine the incidence of asymptomatic recurrences of atrial fibrillation (AF) by daily transtelephonic (TT) electrocardiographic (ECG) monitoring, as compared with standard ECG and 24-h Holter recording, in patients who underwent radiofrequency catheter ablation (RCA) of AF.

BACKGROUND: The efficacy of RCA of AF is usually evaluated by means of patients’ symptoms.

METHODS: Seventy-two patients with paroxysmal (n = 37) or persistent (n = 35) drug-refractory AF underwent circumferential RCA of the pulmonary vein (PV) ostia. Left isthmus ablation was performed in 57 patients, and cavotricuspid isthmus ablation was done in 69 patients. Patients were scheduled to obtain an ECG and Holter recordings one and four months after ablation, as well as a daily TT ECG, from 30 to 120 days after ablation or in the event of symptoms.

RESULTS: A total of 5,585 TT ECGs were obtained (mean 77.5 per patient). In 20 patients (27.8%), AF recurrences were recorded during TT ECG, whereas ECG and Holter monitoring revealed AF recurrences in 10 patients (13.9%, p = 0.001). Ten patients had at least one asymptomatic AF recurrence, and eight were completely asymptomatic. The ECG recorded in the event of symptoms always showed AF.

CONCLUSIONS: Transtelephonic ECG is better than standard ECG and 24-h Holter recordings in evaluating AF relapses after RCA, thus decreasing the short-term success of ablation from 86% to 72%. The absence of symptoms should not be interpreted as absence of AF, as 50% of patients were asymptomatic during at least one AF episode.

Abbreviations and Acronyms   AF = atrial fibrillation   ECG = electrocardiogram   PV = pulmonary vein   RCA = radiofrequency catheter ablation   TT = transtelephonic

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