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Atrial Fibrlllation Patient

ATRIAL FIBRILLATION MANAGEMENT CARDIAC DIAGNOSTICS & MONITORING

Ongoing cardiac monitoring for management of atrial fibrillation

Atrial Fibrillation Management

  • HRS Ablation Guidelines recommend continuous ECG monitoring for pre and post-AF ablation burden to measure clinical success and where physicians desire to stop anti-coagulation therapy.1
  • New-onset atrial fibrillation occurs in 55% of post-atrial flutter ablation patients 62 days post-ablation.2

Atrial Fibrillation is Difficult to Detect

Intermittent and symptom-based monitoring is inaccurate for identifying patients with AF3

  • Identification of patients with any AF/AT (sensitivity)
    • 46% with quarterly Holter monitoring
    • 56% as a result of symptom-based monitoring

Patient symptoms are not a reliable source to determine AF prevalence4

  • ~90% of AF episodes may be asymptomatic
  • ~20% of symptoms may relate to AF episodes

GUIDELINES

INSERTABLE CARDIAC MONITORING

2012 HRS Ablation Guidelines - Monitoring Highlights & Updates1

Clinical/Partial Success

  • Clinical/partial success is defined as a 75% or greater reduction in the number of AF episodes, the duration of AF episodes, or the % time a patient is in AF as assessed with a device capable of measuring AF burden in the presence or absence of previously ineffective antiarrhythmic drug therapy.

Post-Procedure OAC Management

  • Patients in whom discontinuation of systemic anticoagulation is being considered should consider undergoing continuous ECG monitoring to screen for asymptomatic AF/AFL/AT.

AF Burden: Consider As Secondary Endpoint

  • Another endpoint that should be considered in clinical trials is an assessment of “AF burden” at various points in time during follow-up. It is essential that the method used for monitoring in the treatment and control arms be reported as part of this type of analysis.

ACC/AHA Ambulatory ECG Guidelines 20005

These guidelines represent some of the current common clinical uses of ambulatory ECG.

For Assessment of Symptoms of Cardiac Arrhythmias

Class Recommended Use
Class

I

 Recommended Use
  1. Patients with unexplained syncope, near syncope, or episodic dizziness without obvious cause.
  2. Patients with unexplained recurrent palpitation.
Class

IIb

 Recommended Use
  1. Patients with episodic shortness of breath, chest pain, or fatigue that is not otherwise explained.
  2. Patients with neurologic events when transient atrial fibrillation or flutter is suspected.
  3. Patients with symptoms such as syncope, near syncope, episodic dizziness, or palpitation in whom a probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause.
1

Calkins, et al. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2007 Jun;4(6):816-61.

2

Fetsch T, Bauer P, Engberding R, et al. Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. Eur Heart J. August 2004;25(16):1385-1394.

3

Ziegler PD, Koehler JL, Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. December 2006;3(12):1445-1452.

4

Strickberger, S.A., J. Ip, et al. "Relationship between atrial tachyarrhythmias and symptoms." Heart Rhythm.

5

ACC/AHA Guidelines for Ambulatory Electrocardiography: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). JACC 1999.