Lb-456091-2 dynamic data driven management of atrial fibrillation using implantable cardiac monitors – the monitor af study

Management of atrial fibrillation (AF) is often complex and dynamic. Clinical decisions related to initiation of rate control, rhythm control strategies, stroke prophylaxis measures depend on the assessment of the presence and the burden of AF. Assessment of therapy outcomes and withdrawl of drugs and anticoagulation are guided by AF monitoring. Implantable cardiac monitors (ICM) are excellent tools to detect and monitor AF burden in a dynamic fashion. We prospectively studied if the presence of an ICM impacts the management of AF and there by clinical outcomes. In this multi-institutional prospective registry, we enrolled AF patients who have an ICM versus those who did not. We measured the differences in various aspects of AF management including – access to care, time to initiation and change of antiarrhythmic drugs, time to ablation. Data points related to arrhythmia recurrence, redo ablation, time to withdrawl of AADs and OAC; and AF related complications including – Systemic thromboembolic events, hospitalizations related to AF and heart failure exacerbation, bleeding complications. Patients with Pacemakers and implantable defibrillators, ICMs for cryptogenic stroke and those who had AF ablation prior to enrollment were excluded. A total of 2458 patients were enrolled in the study (ICM group – 1152, Non-ICM group-1306). There was no significant difference in the demographics or other baseline data. (Mean age 73±12 vs 74±10, p=0.78; Males 65±5 vs 62±6, p=0.56; Paroxysmal AF 68±5 vs 65±6, p=0.34). During a mean follow up of 24 months – median time to AAD start (36 vs 46 days), Time to first ablation ( 5 vs 14 months), No. of external monitors used (0 vs 4) and time to redo ablation (73 vs 165 days) were significantly better in the ICM than the Non-ICM group. The other relevant AF management outcomes and complications are outlined in the Figure-1. Dynamic monitoring of AF allows for significantly improved care pathways leading to early intervention, improved rhythm control and signifciant reduction in AF related morbidity and mortality. Similar to Diabetes manaement - AF management should be guided by data and the AF burden rather than a point time brief assessment of rhythm using external monitors. AF management using ICM is superior to conventional approach. This leads to early therapy, better rhythm control and also decrease the risk of AF related complications due to dynamic monitoring and early intervention.