학술논문
Influence of monitoring and atrial arrhythmia burden on quality of life and health care utilization in patients undergoing pulsed field ablation: A secondary analysis of the PULSED AF trial.
Document Type
Academic Journal
Author
Verma A; McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: atul.verma@mcgill.ca.; Haines DE; Beaumont Health, Royal Oak, Michigan.; Boersma LV; St. Antonius Hospital, Nieuwegein and Amsterdam UMC, The Netherlands.; Sood N; Southcoast Health Center, Fall River, Massachusetts.; Natale A; Texas Cardiac Arrhythmia Institute, Austin, Texas.; Marchlinski FE; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.; Calkins H; Johns Hopkins Hospital, Baltimore, Maryland.; Sanders P; University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.; Packer DL; Mayo Clinic-St. Mary`s Hospital, Rochester, Minnesota.; Kuck KH; LANS Cardio, Hamburg, Germany.; Hindricks G; Heart Center-University of Leipzig, Leipzig, Germany.; Tada H; University of Fukui, Fukui, Japan.; Hoyt RH; Iowa Heart Center, West Des Moines, Iowa.; Irwin JM; BayCare St. Joseph's Hospital, Tampa, Florida.; Andrade J; Vancouver General Hospital, Vancouver, British Columbia, Canada.; Cerkvenik J; Medtronic, Inc., Minneapolis, Minnesota.; Selma J; Medtronic, Inc., Minneapolis, Minnesota.; DeLurgio DB; Emory Heart & Vascular Center at Saint Joseph's, Atlanta, Georgia.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Freedom from atrial arrhythmia (AA) recurrence ≥30 seconds after pulsed field ablation (PFA) in patients with atrial fibrillation (AF) was reported in PULSED AF (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF; ClinialTrials.gov Identifier: NCT04198701). AA burden may be a more clinically meaningful endpoint.
Objective: The purpose of this study was to determine the influence of monitoring strategies on AA detection and AA burden association with quality of life (QoL) and health care utilization (HCU) after PFA.
Methods: Patients underwent 24-hour Holter monitoring at 6 and 12 months and weekly, and symptomatic transtelephonic monitoring (TTM). AA burden post-blanking was calculated as the greater of (1) percentage of AA on total Holter time; or (2) percentage of weeks with ≥1 TTM with AA out of all weeks with ≥1 TTM.
Results: Freedom from all AAs varied by >20% when differing monitoring strategies were used. PFA resulted in zero burden in 69.4% of paroxysmal atrial fibrillation (PAF) and 62.2% of persistent atrial fibrillation (PsAF) patients. Median burden was low (<9%). Most PAF and PsAF patients had ≤1 week of AA detection on TTM (82.6% and 75.4%) and <30 minutes of AA per day of Holter monitoring (96.5% and 89.6%), respectively. Only PAF patients with <10% AA burden averaged a clinically meaningful (>19 point) QoL improvement. PsAF patients experienced clinically meaningful QoL improvements irrespective of burden. Repeat ablations and cardioversions significantly increased with higher AA burden (P <.01).
Conclusion: The ≥30-second AA endpoint is dependent on the monitoring protocol used. PFA resulted in low AA burden for most patients, which was associated with clinically relevant improvement in QoL and reduced AA-related HCU.
(Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Objective: The purpose of this study was to determine the influence of monitoring strategies on AA detection and AA burden association with quality of life (QoL) and health care utilization (HCU) after PFA.
Methods: Patients underwent 24-hour Holter monitoring at 6 and 12 months and weekly, and symptomatic transtelephonic monitoring (TTM). AA burden post-blanking was calculated as the greater of (1) percentage of AA on total Holter time; or (2) percentage of weeks with ≥1 TTM with AA out of all weeks with ≥1 TTM.
Results: Freedom from all AAs varied by >20% when differing monitoring strategies were used. PFA resulted in zero burden in 69.4% of paroxysmal atrial fibrillation (PAF) and 62.2% of persistent atrial fibrillation (PsAF) patients. Median burden was low (<9%). Most PAF and PsAF patients had ≤1 week of AA detection on TTM (82.6% and 75.4%) and <30 minutes of AA per day of Holter monitoring (96.5% and 89.6%), respectively. Only PAF patients with <10% AA burden averaged a clinically meaningful (>19 point) QoL improvement. PsAF patients experienced clinically meaningful QoL improvements irrespective of burden. Repeat ablations and cardioversions significantly increased with higher AA burden (P <.01).
Conclusion: The ≥30-second AA endpoint is dependent on the monitoring protocol used. PFA resulted in low AA burden for most patients, which was associated with clinically relevant improvement in QoL and reduced AA-related HCU.
(Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)