Prognostic Value Of Overnight Holter Monitor Post Pulmonary Vein Isolation

Introduction: Pulmonary vein isolation (PVI) is effective for management of atrial fibrillation (AF). However, early prediction of its outcome is not feasible as a blanking period of up to 3 months post ablation is typically recommended. Purpose: Our aim is to evaluate the value of overnight holter monitor for early prediction of long-term success of PVI. Methods: We reviewed data of consecutive patients who underwent PVI between Dec 2010 and July 2012. The procedure included isolation of all pulmonary veins and left atrial substrate modification as needed. The overnight post ablation holter monitor results was analyzed as a predictor of long-term success defined as freedom from any atrial arrhythmia lasting more than 30 seconds after a 3 month blanking period. Results: Our study included 958 consecutive patients: mean age 61.2 ± 10.4, 256 (27%) females, median AF duration of 4 years (Q1-Q3: 2,8), 422 (44%) persistent AF, CHA2DS2VASC score 2 (Q1-Q3: 1,3), mean ejection fraction (EF) of 54.5% ± 9.4. mean left atrium diameter of 4.26 ± 0.9 cm. The results of the overnight holter monitor were available for 951 patients. The mean heart rate post ablation was 72.5 ± 12 bpm. 56 (6%) patients had recurrent arrhythmia overnight (34 paroxysmal AF, 12 persistent AF). On long-term follow of 490 days (Q1-Q3: 202, 809). 454 (47%) patients had recurrent atrial arrhythmia (41% in patients with paroxysmal AF and 55% in those with persistent AF). 46 (82%) of the 56 patients who had recurrent arrhythmia on holter monitor within 24 hours of PVI had late recurrence on long-term follow up. Conclusion: Recurrent arrhythmia within 24 hours of atrial fibrillation ablation is uncommon. However, it is strongly associated with recurrent arrhythmia on long-term follow up. Closer monitoring and early management of recurrent arrhythmia should be considered those patients.