Systematic Review/Meta-analysis Rhythm-Monitoring Strategy and Arrhythmia Recurrence in Atrial Fibrillation Ablation Trials: A Systematic Review

Background: : The rhythm-monitoring strategy after catheter ablation (CA) for atrial fibrillation (AF) impacts the detection of atrial arrhythmia recurrence and is not well characterized. We performed a systematic review and meta-regression analysis to determine whether the duration and mode of rhythm monitoring after CA affects detection of atrial arrhythmia recurrence.Methods: Databases were systematically searched for randomized controlled trials of adult patients undergoing first CA for AF from 2007 to 2021. Duration and strategy of rhythm monitoring were extracted. Metaregression was used to identify any association between duration of monitoring and detection of atrial arrhythmia recurrence. The primary measure of outcome was single-procedure recurrence of arrhythmia.Results: The search strategy yielded 57 trial arms from 56 random- ized controlled trials comprising 5322 patients: 36 arms of patients with paroxysmal AF (PAF), and 21 arms of patients with persistent (PeAF) or both PAF/PeAF. Intermittent monitoring was associated detection of significantly less atrial arrhythmia recurrence continuous monitoring in PAF arms (31.2% vs 46.9%, P = 0.001), not in PeAF/PAF-PeAF combined arms (43.3% vs 63.6%, P = 0.12). No significant relationship was seen between the duration of mittent rhythm monitoring and atrial arrhythmia recurrence detection in either the PAF (P = 0.93) or PeAF/PAF-PeAF combined arms 0.20).Conclusions: Continuous rhythm monitoring detected higher arrhythmia recurrence rates, compared to intermittent rhythm toring, in patients with PAF. The duration of intermittent monitoring not show a statistically significant relationship to the yield arrhythmia detection, in near identical cohorts of trial subjects dergoing similar interventions, with clinical and research implications.