Background: Although atrial fibrillation (AF) ablation is a well-established treatment, the classical definition of recurrence and therefore success is not evidence-based. Additionally, the frequency of asymptomatic patients whose episodes are not noticed on routine electrocardiogram (ECG) may compromise the actual success rate. Objectives: This study aimed to assess the characteristics of AF burden after atrial fibrillation ablation and its influence on patients’ symptoms in the setting of continuous remote monitoring. It also sought to investigate a relevant cutoff as a new definition for recurrence. Methods: 141 consecutive patients with symptomatic paroxysmal or persistent AF underwent an AF ablation and then were followed by continuous rhythm monitoring. The AF/atrial tachycardia (AT) burden, duration of episodes and symptoms where registered systematically. Results: After the blanking period, freedom from AF/AT >30sec. was 59%. Considering an AF-Burden <1%, the success rate was 80%. The incidence of asymptomatic episodes in the group of patients with conventional recurrence was 24% (14/58) and 20% (8/41) when a cut-off of 1% of AF/AT burden was considered. Asymptomatic patients had an AF burden of 1.87 ± 4.6% during follow-up, compared to 4.0 ± 7.2% in symptomatic patients (p=0.02). There was no statistical difference between AF type (paroxysmal vs. persistent) and the frequency of asymptomatic episodes. Conclusions: Patients with asymptomatic AF Episodes represent a significant proportion after AF ablation. These patients could be easily overlooked without a proper monitoring technique. A burden cutoff of 1% and freedom from symptom should be considered as an ablation endpoint.
Objective: Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder (Boston Scientific) remains uncertain. This study aimed to investigate the efficacy and safety of a 3-month dual antiplatelet therapy (DAPT) after LAAC. Methods: This was a post hoc analysis of a prospective study of patients who underwent successful LAAC with Watchman devices at the REGIOMED Hospitals of Coburg and Lichtenfels (Germany). Those treated from 11/2016 to 05/2018 received DAPT for 3 months (DAPT group); those from 02/2012 to 04/2017 received 45-day anticoagulant+aspirin followed by 4.5-month DAPT (ACT group). The primary efficacy outcome and safety outcome were analyzed. The net clinical benefit and bleeding events 1 year after treatment, and their independent risk factors were also explored. Results: There were 220 and 304 patients in the DAPT and ACT groups. The primary efficacy outcome were 9.5% vs. 6.3% [hazard ratio (HR), 1.58; 95% confidence interval (CI), 0.84-2.97; P=0.14]; the primary safety outcome were 4.5% vs. 5.9% (HR, 0.80; 95% CI, 0.38-1.69; P=0.57); the net clinical benefit were 13.6% vs. 11.8% (HR, 1.23; 95% CI, 0.75-2.02; P=0.39) over 1 year in DAPT and ACT groups, respectively. Age ≥75 years (HR, 2.08; 95%CI, 1.13-3.84; P=0.02) was identified as an independent predictor for the net clinical benefit. ACT (HR, 1.97; 95%CI, 1.12-3.50; P=0.02) was independently associated with bleeding events after procedure. Conclusions: In patients who underwent LAAC using the Watchman occluder, 3-month DAPT is associated with fewer bleeding events compared with ACT regimen.