Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF): A Prospective, Multicenter Study
Abstract
BACKGROUND: The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation. METHODS: Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms. RESULTS: Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (P < .001), and 56.0% of all episodes were asymptomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P = .002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF. CONCLUSIONS: The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00745706.
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Symptomatic and asymptomatic atrial fibrillation recurrences are frequent after catheter ablation.
“Patient should also be aware that symptomatic and asymptomatic AF recurrences are frequent after catheter ablation.119,781,782”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [782]
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- Authors
- Verma, A., Champagne, J., Sapp, J., Essebag, V., Novak, P., Skanes, A., Morillo, C. A., Khaykin, Y., & Birnie, D.
- Affiliations
- Southlake Regional Health Center (CA)
- Corresponding author
- Verma, Atul
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-28
- Volume
- 173
- Issue
- 2
- Pages
- 149
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2054893624
- Cited by
- 315
- References
- 30
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 25 · 2023: 14 · 2022: 18 · 2021: 26 · 2020: 15 · 2019: 26 · 2018: 20 · 2017: 30 · 2016: 28 · 2015: 23 · 2014: 40 · 2013: 15 · 2012: 3
- FWCI
- 16.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, catheter ablation, radiofrequency ablation, asymptomatic atrial fibrillation, implantable cardiac monitors, arrhythmia burden, atrial flutter, atrial tachycardia, heart rate variability, automated arrhythmia detection, predictors of recurrence, atrial fibrillation recurrence
- MeSH terms
- Aged, Atrial Fibrillation, Atrial Flutter, Canada, Female, Humans, Male, Middle Aged, Prospective Studies, Tachycardia, Supraventricular, Electrocardiography, Ambulatory, Incidence, Treatment Outcome, Catheter Ablation, Asymptomatic Diseases
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