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Accuracy of symptoms and pulse checking for detecting atrial fibrillation following catheter ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

There is growing interest in the possibility of discontinuing oral anticoagulation following successful catheter ablation of atrial fibrillation (AF). However, it remains unknown whether patients can accurately detect arrhythmia recurrences following ablation. We therefore sought to characterize the accuracy of pulse checking and arrhythmia symptoms for the identification of AF following ablation.

Methods

This prospective cohort study included patients at the Hospital of the University of Pennsylvania with an insertable cardiac monitor (ICM) treated with catheter ablation for AF who recorded the results from minimum twice daily pulse checks and additionally with arrhythmia symptoms into a diary for 2 months following their procedure. Accuracy of this self-assessment protocol was determined by comparison to ICM-detected AF.

Results

A total of 55 patients (age 69 ± 8 years, 30 (55%) male, CHA2DS2VASc score 3.2 ± 1. 5) were included. Patients recorded a total of 5911 pulse checks, and there were 280 episodes of ICM-documented AF among 26 patients with an average duration of 2.5 ± 3.3 h. Among 362 episodes of patient-suspected AF, 134 correlated with ICM-identified AF (37% true positive rate). Of the 5549 pulse checks that did not identify AF, 196 correlated with ICM-identified AF (4% false negative rate). Twice daily pulse checking had a sensitivity of 47% and a specificity of 96% for identifying each episode of AF.

Conclusions

Our data indicate that a strategy of pulse checks and symptom assessment is insufficient to identify all episodes of AF in many patients following catheter ablation.

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Data availability

 The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

OAC:

Oral anticoagulation

ICM:

Insertable cardiac monitor

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Funding

Funding was provided by the Mark Marchlinski EP Research & Education Fund and the F. Harlan Batrus EP Research Fund.

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Authors and Affiliations

  1. Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Timothy M. Markman, Carli Peters, Simone Tate, Gustavo S. Guandalini, Matthew C. Hyman, Robert D. Schaller, Gregory E. Supple, Michael P. Riley, Fermin Garcia, Saman Nazarian, David Lin, Sanjay Dixit, Andrew E. Epstein, David J. Callans, Francis E. Marchlinski & David S. Frankel

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  1. Timothy M. Markman
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  2. Carli Peters
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Corresponding author

Correspondence to David S. Frankel.

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Ethical approval

The research was approved by the Hospital of the University of Pennsylvania Institutional Review Board.

Informed consent

Written informed consent was obtained from all patients.

Conflict of interest

Dr. Frankel receives consulting fees and lecture honoraria from Abbott, Boston Scientific, and Medtronic. Dr. Markman receives consulting fees from Medtronic.

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Markman, T.M., Peters, C., Tate, S. et al. Accuracy of symptoms and pulse checking for detecting atrial fibrillation following catheter ablation. J Interv Card Electrophysiol 67, 617–623 (2024). https://doi.org/10.1007/s10840-023-01643-4

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  • DOI: https://doi.org/10.1007/s10840-023-01643-4

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