Role of Continuous Monitoring for Optimizing Management Strategies in Patients With Early Arrhythmia Recurrences After Atrial Fibrillation Ablation

Arrhythmia recurrences early after the procedure are not uncommon in patients undergoing atrial fibrillation (AF) ablation.1,2 These typically manifest as AF and/or organized atrial tachyarrhythmias (OATs) and can be encountered in as many as 45% of subjects for up to 3 months after the procedure.3 The mechanism underlying early recurrence of atrial arrhythmias (ERA) remain poorly understood but have been attributed to stimulatory effect of radiofrequency energy, imbalance in the autonomic supply of the heart, a generalized inflammatory state, and so forth, all of which are considered transient.3–5 Consistent with this hypothesis, up to 60% of patients manifesting ERA eventually become arrhythmia free without needing another ablation.1,2 Thus, at the present time it is common practice to treat ERA conservatively. This approach is also supported by the HRS/EHRA/ECAS consensus statement, which recommends against immediate reablation for such early arrhythmia occurrences.3 However, as our experience with AF ablation has grown, there is evidence supporting a strong and independent association between ERA and long-term recurrence of AF.1,2,7 These findings cast ERA in a new light and suggest that their occurrence may in fact reflect reestablishment of the original AF substrate. If this is true, then it would support a role for early repeat ablation in patients manifesting ERA. However, such an approach has not been widely adopted. This is probably because of reluctance on the part of physicians to perform early reablation because only half the patients manifesting ERA will have long-term AF recurrence. Thus, what is lacking currently is a better understanding of the corelationship between ERA events and future AF occurrences. This gap in our knowledge is largely due to our inability to continuously monitor patients after the AF ablation procedure. The monitoring modalities …