Table 5

Complications and monitoring

Author (year)Definition of relapseMonitoring for AF/AT relapseProcedural-related complications
Liu et al (2005)14Any episode of AF, regardless of duration, was considered as arrhythmia recurrence.ECG, 24 h Holter and echocardiography 1, 3, 6 and 9 months after ablation. Monthly telephone interviews. Three patients had a telemetric ECG recorder for 6 months. Two patients had device interrogation.Major: none.
Kilicaslan et al (2006)15Recurrences were based on patient reporting and rhythm transmitter, Holter and/or ECG data.Outpatient clinic at 3, 6, 12 months and 6 months thereafter. Rhythm transmitter used in the first 3 months (extra 3 months if early recurrence). Forty-eight-hour Holter recording at 3, 6 and 12 months.Major: asymptomatic PV stenosis: <50% in two patients (7%) and 50%–69% in two patients (7%).
Gaita et al (2007)16Any documented recurrence of AF based on ECG recordings after 4 weeks of blanking.Clinical evaluation, 12-lead ECG, echocardiogram and 24 h Holter monitor at 1, 3, 6, 12 months and every 6 months thereafter.Major: none.
Mild pericardial effusion in five patients (21.7%).
Bunch et al (2008)17AF elimination if no documented AF episodes in the absence of AADs. AF control if remaining in SR without relapse while on AADs.Telephone contact, clinic follow-up visits and/or communication with referring physician. ECGs and 24 h Holter in subsequent clinical visits.Major: two patients had a periprocedural TIA and one developed a symptomatic PV stenosis.
Di Donna et al (2010)18Recurrence of AF, AT or atrial flutter lasting >3 min.Patients followed at 1, 3, 6 and 12 months with ECG, echocardiography and 24 h Holter and every 6 months thereafter through telephone contact, clinic follow-up visits and communication with the referring physician.Major: none.
Five (8%) patients developed mild non-haemodynamic comprising pericardial effusion.
McCready et al (2011)19Episode of AF or AT >30 s documented on Holter monitoring or any 12-lead ECG documentation after initial 3 months blanking (on or off AADs).12-lead ECGs, Holter monitoring for 1–7 days and pacemaker/implantable cardioverter-defibrillator interrogation (where available).Major: cardiac tamponade in one patient (7.1%).
Derejko et al (2013)20Recurrence of AF, atrial flutter or AT lasting >3 min, after the initial 3 months documented on ECG or EGM.Clinical appointment, ECG and Holter at 4 weeks and then every 3–6 months. Eight patients underwent 2 weeks of continuous ECG monitoring.Major: stroke resolving without sequel after a redo procedure.
Santangeli et al (2013)21Any episode of AF/AT lasting for ≥30 s after initial 3 months blanking.Physical examination, ECG and 7-day Holter monitoring at 3, 6, 9 and 12 months. Event recorder in the first 5 months.Major: none.
Yan et al (2013)22N.A.N.A.Major: none.
Hayashi et al (2014)23Episode of AF or AT lasting for >30 s after the 3-month blanking period.Outpatient clinic with ECG every month for the first 12 months and every 2–3 months thereafter. Cardiac event recorder used twice a day for 30 s ×2 during the first 4 months. A 24 h Holter monitor 3 months after the procedure and every 12 months thereafter.Major: none.
Contreras-Valdes et al (2015)24Recurrent arrhythmia (AF or AT) after initial 3-month blanking.N.A.Complications: rare.
Median hospitalisation was longer in HCM 2 (1–6) vs 1 (1–3), p<0.0001. Longer readmission rate at 30 days in HCM 25% vs 1.6%, p<0.0003 (HF and congestive symptoms).
Müssigbrodt et al (2015)25Documented episodes of sustained (>30 s) AF or atrial flutter after a 3-month blanking period.7-day Holter recordings during 6-month, 12-month and 24-month follow-up visits. Interrogation of implantable cardiac devices.Major: PV stenosis requiring balloon dilation in one patient with HCM.
Okamatsu et al (2015)26Recurrence of AF lasting > 1 min, following a 2-month blanking period.Clinical review, ECG and 24 h Holter every 1–3 months.N.A.
Wen et al (2015)27Episode of documented atrial tachyarrhythmia lasting at least 30 s after a 3-month blanking period.ECG, 24 h Holter at 1, 3, 6 and 12 months and every 6 months thereafter. Phone interviews.N.A.
  • AADs, antiarrhythmic drugs; AF, atrial fibrillation; AT, atrial tachycardia; EGM, intracavitary electrograms; HCM, hypertrophic cardiomyopathy; HF, heart failure; N.A., not available; PV, pulmonary vein; SR, sinus rhythm; TIA, transient ischaemic attack.