Perception of atrial fibrillation before and after radiofrequency catheter ablation: clinical relevance of asymptomatic arrhythmia recurrence based on a detailed analysis of more than 75.000 hours of ecg-recordings

Background Due to the investigative nature of AF catheter ablation, currently only highly symptomatic patients are treated. Remarkable success rates have been reported repeatedly. However, the follow up strategies measuring that outcome are largely based on symptomaticity. Therefore the present study aimed on analyzing the perception of AF in 114 pts. before and after a left atrial catheter ablation using the CARTO System. Methods A digital 7-d-ECG was recorded prior to ablation, right after ablation, after 3 months, after 6 months and after 12 months. During the 7-d-ECG the pts. hourly registered quality and duration of any symptoms in a certain patient's log. Palpitation, dyspnoea, dizziness and chest pain were taken as surrogates of AF. Subsequently the amount of time with symptomatic AF, asymptomatic (ASYM) AF, symptomatic SR and ASYM SR was measured. Additionally the individual AF episode was classified as either symptomatic or ASYM. Results For more than 75000 hours of ECG recording symptoms and rhythm were correlated. Prior ablation 54% of the time in AF and 22% of the AF episodes were ASYM. After ablation the proportion of ASYM AF episodes increased from 22% to 53% of all AF episodes. Watching the individual patient ASYM AF was common in 65% of all pts. with AF before and after catheter ablation. Nevertheless, the percentage of pts. with only ASYM AF during the 7-d-ECG increased from 10% prior ablation to 36% 6 months after ablation. Conclusions Pts. with highly symptomatic AF also exhibit a substantial amount of ASYM arrhythmia (54% of AF time, 22% of AF episodes). After ablation the amount of ASYM AF increased, with half of the episodes being ASYM. Furthermore, 36% of the pts. with AF recurrences at the 6 months follow up were completely ASYM during that 7-d-ECG. Our data show, that a judgement on the efficacy of percutaneus AF ablation based on patient's symptoms substantially overestimates the success rate. Objective follow up strategies, applied in a close manner, are needed for a through measurement of the real outcome.