Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence
Abstract
Background— The objective of this study was to assess the incidence and impact of asymptomatic arrhythmia in patients with highly symptomatic atrial fibrillation (AF) who qualified for radiofrequency (RF) catheter ablation. Methods and Results— In this prospective study, 114 patients with at least 3 documented AF episodes together with corresponding symptoms and an ineffective trial of at least 1 antiarrhythmic drug were selected for RF ablation. With the use of CARTO, circumferential lesions around the pulmonary veins and linear lesions at the roof of the left atrium and along the left atrial isthmus were placed. A continuous, 7-day, Holter session was recorded before ablation, right after ablation, and after 3, 6, and 12 months of follow-up. During each 7-day Holter monitoring, the patients recorded quality and duration of any complaints by using a detailed symptom log. More than 70 000 hours of ECG recording were analyzed. In the 7-day Holter records before ablation, 92 of 114 patients (81%) had documented AF episodes. All episodes were symptomatic in 35 patients (38%). In 52 patients (57%), both symptomatic and asymptomatic episodes were recorded, whereas in 5 patients (5%), all documented AF episodes were asymptomatic. After ablation, the percentage of patients with only asymptomatic AF recurrences increased to 37% ( P <0.05) at the 6-month follow-up. An analysis of patient characteristics and arrhythmia patterns failed to identify a specific subset who were at high risk for the development of asymptomatic AF. Conclusions— Even in patients presenting with highly symptomatic AF, asymptomatic episodes may occur and significantly increase after catheter ablation. A symptom-only–based follow-up would substantially overestimate the success rate. Objective measures such as long-term Holter monitoring are needed to identify asymptomatic AF recurrences after ablation.
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Catheter ablation may increase the proportion of AF events that are asymptomatic, probably by alteration of cardiac neural element.
“Indeed, catheter ablation may increase the proportion of AF events that are asymptomatic, probably by alteration of cardiac neural element (Hindricks et al., 2005).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Hindricks et al., 2005
The Main Findings section reports that asymptomatic AF increased after ablation. The Perception of AF After Catheter Ablation section suggests that effects on the heart’s autonomic nervous system may affect AF perception, but says the mechanism is not completely understood and needs further study. The claim’s “probably by alteration” states that explanation more confidently than the source does. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSymptomatic 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 [119]
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- Authors
- Hindricks, G., Piorkowski, C., Tanner, H., Kobza, R., Gerds-Li, J.-H., Carbucicchio, C., & Kottkamp, H.
- Affiliations
- Leipzig University (DE)
- From the Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany.
- ORCID
- Venue
- Circulation
- Published
- 2005-07-19
- Volume
- 112
- Issue
- 3
- Pages
- 307-313
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1988904908
- Cited by
- 506
- References
- 14
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 9 · 2023: 11 · 2022: 14 · 2021: 14 · 2020: 15 · 2019: 20 · 2018: 15 · 2017: 18 · 2016: 19 · 2015: 17 · 2014: 34 · 2013: 28 · 2012: 37
- FWCI
- 27.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (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, asymptomatic atrial fibrillation, radiofrequency catheter ablation, atrial fibrillation recurrence, Holter monitoring, pulmonary vein isolation, antiarrhythmic drug failure, long-term follow-up
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Female, Heart Rate, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Catheter Ablation
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