Open AccessDiagnostic value of implantable loop recorder in patients undergoing cryoballoon ablation of atrial fibrillation
Author(s) -
Kusiak Aleksander,
Jastrzębski Marek,
Bednarski Adam,
Kułakowski Piotr,
Piotrowski Roman,
Koźluk Edward,
Baszko Artur,
Czarnecka Danuta
Publication year - 2020
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12733
Subject(s) - medicine , implantable loop recorder , atrial fibrillation , ablation , cardiology , atrial tachycardia , tachycardia , catheter ablation
Background Due to limited data, implantable loop recorders (ILR) are not currently recommended by the guidelines to routinely monitor patients after atrial fibrillation (AF) ablation. Aims To validate the diagnostic value of ILR after AF ablation, modern generation ILRs (LINQ) were implanted in patients scheduled for cryoballoon ablation of AF (CBA). Methods We included 29 patients with frequent and symptomatic episodes of paroxysmal AF. ILR was implanted 3 months prior to CBA, and data were collected before and for 6 months after the procedure. The device was programmed to maximize sensitivity of AF/ atrial tachycardia (AT) detection. All EGM recordings were “manually” assessed and annotated as true AF, pseudo AF, unrecognized AF, and episodes with no EGM available. Duration and episode‐based standard performance metrics were evaluated. Results A total number of 5,842 episodes were recorded. A total of 4,403 episodes were true AF, 453 episodes were pseudo AF, and 986 episodes had no EGM available. The device did not recognize 144 episodes of AF. Duration‐based sensitivity was 95.2%, duration‐based specificity 99.9%, duration‐based PPV 99.2%, duration‐based NPV 99.9%, episode‐based sensitivity 98.0%, and episode‐based PPV 91.0%. Misdiagnosis happened in 1 in 10 episodes. Total data review time was 166 hr. Conclusions Implantable loop recorders is a valuable tool in evaluation of AF episodes in patients undergoing CBA. However, for high precision all recorded episodes need to be evaluated “manually.” The memory storage space is too low for frequent AF episodes, resulting in overwriting of stored EGMs and data loss.