APPLICATION OF IMPLANTABLE LOOP RECORDER FOR DETECTION OF RECURRENCE OF ARRHYTHMIA AND SELECTION OF PATIENTS FOR EARLY RE-ABLATION OF ATRIAL FIBRILLATION

To develop management strategy for patients with recurrence of atrial fibrillation (AF) in the early post-operation period based on the loop recorder data, 314 patients were included into the study. Group 1 included patients with no recurrence of arrhythmia in the early post-operation period; Group 2 consisted of 182 patients (58%) with recurrence of the arrhythmia. The subjects of Group 2 were randomized into Group 3 (n=88) or Group 4 (n=89); 5 patients were excluded from the study. The Group 3 subjects received only medical antiarrhythmic therapy. In Group 4, management of early post-operation period depended on the AF mechanism recorded by the loop recorder. In the case of the first occurrence of AF, only antiarrhythmic therapy was prescribed; if AF was induced by any trigger activity, the early re-ablation was carried out. The pulmonary vein ostia antral isolation by the common collectors was performed in all study subjects with creation of ablation lines on the roof of the left atrium and mitral isthmus. The loop recorder implantation was carried out as a final stage of the operation. After 12 months of follow-up, 120 of 129 patients of Group 1 (95%) were responders. Only 29 of 88 patients of Group 3 (33%) were responders (p<0.001, as compared with Group 1). In Group 4, 71 patients of 89 (80%) were responders (p=0.001, as compared with Group 1; p<0.0001, as compared with Group 3). In Group 3, 24 patients of 35 (69%) with the sudden AF onset were responders, as compared with only 6 patients of 52 (8 %) with the trigger AF onset (p<0.0001 as compared with the subjects with sudden AF onset). In Group 4, 22 patients of 32 (63%) with the sudden AF onset were responders (p=0.38, as compared with the patients with sudden AF onset in Group 3). Among 57 patients with the trigger AF induction, 49 ones (89 %) were responders (p=0.003 as compared with the sudden AF onset and p<0.001 as compared with the trigger onset in the patients of Group 3).

atrial fibrillation, atrial flutter, atrial premature beats, pulmonary veins, radiofrequency ablation, early recurrence, loop recorder

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