Be Proactive About Monitoring After Your Atrial Fibrillation Ablation
June 03, 2009 5:41 AM CT
If you have afib and have had a catheter ablation or a surgical ablation, chances are you spent a lot of time researching about afib, the procedure you underwent, and outcomes. However, there is one aspect post surgery that, as patients, we all need to consider—post-procedure monitoring and follow up.
Dr. James Edgerton presented results of his post-surgery monitoring research at the AF Summit at Heart Rhythm 2009 in Boston. He reported that there is great variability between doctors regarding what is considered a successful intervention and how they monitor a patient after a procedure.
How a doctor defines success and how they monitor you are important for you as a patient and are why you should advocate for stringent follow up monitoring based upon clinical evidence.
After an ablation, some doctors rely on patient reports of afib episodes as part of their follow up. However, after a procedure, this type of reporting is only about 50% accurate as patients may have many more silent episodes of afib. This type of follow up substantially overestimates success rates, which could be detrimental to you.
Why? As patients with afib know, developing a clot and subsequent stroke as a result of having atrial fibrillation is a real concern. Additionally, over time afib can reduce the heart’s ability to pump effectively and possibly contributes to the development of fibrous tissue in the heart.
For these reasons, many of us have used various drugs and blood thinners to prevent a stroke and to help our hearts beat more normally. After surgery, having accurate information about any afib episodes we may be having remains critically important, not only to help a physician make decisions about taking us off of a blood thinner or other medication, but so we can confidently know we don’t have afib anymore.
Dr. Edgerton, in his presentation, described a follow up model that will most reliably capture any abnormal rhythms. Based upon his research, using a 14-day Holter monitor at regular intervals for a minimum of a year is the most efficacious means of determining if abnormal rhythms are present post ablation.
To come to this conclusion, his team performed statistical analyses between different types of follow up, including:
- over the phone patient self report
- a single instance ECG
- a 1-day monitor
- a 7-day monitor
- a 14-day monitor, and
- a 90-day monitor
The 14-day monitor offered the most reliable means of capturing any afib episodes post ablation. The 90-day monitor did not offer any statistically significant advantages in terms of episode capture.
Unfortunately, using a 14-day monitor is not the norm for many physicians. Instead, they rely on patient self-reporting and short term monitors. Dr. Edgerton and his team have found, based upon clinical evidence, that these methods are inaccurate, which can lead to inappropriate clinical decisions post ablation regarding your care.
We as patients need to be aware of the importance of appropriate monitoring and should advocate for using 14-day monitors so our doctors can make clinical decisions regarding our care based upon reliable data. After all, we have to live with the consequences.
Eric Oddleifson reported from the AF Summit at Heart Rhythm 2009 on behalf of StopAfib.org. Eric had undergone minimally invasive surgery for his afib just 3 weeks prior to the AF Summit. He is based in Boston.