Symptoms versus objective rhythm monitoring in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation

BACKGROUND: Pulmonary vein (PV) ablation is a treatment option for patients with atrial fibrillation (AF). The efficacy of treatment is often assessed by the evaluation of symptoms. However, a high proportion of AF episodes occur in the absence of symptoms as observed in pharmacological treated patients. The purpose of this study was to assess the association of symptoms and AF in patients who underwent PV ablation for the treatment of paroxysmal AF. METHODS: All consecutive patients scheduled for PV ablation received an event recorder 1 month prior to the ablation for the period of 4 months. Event strips were sent by telephone on a daily basis, and in case the patient suffered palpitations or other symptoms believed to be related to the arrhythmia. RESULTS: Forty-one patients (7 females; mean age 52 years (range 24 to 71 years)) sent a total of 3,046 event strips (735 before ablation; 2,311 after ablation). Before ablation, a total amount of 244 event strips were obtained of which were 85 (35%) were asymptomatic. After ablation, a total amount of 254 AF event strips were obtained of which 164 were asymptomatic (65%). Correlation between symptoms and rhythm was often absent during AF. CONCLUSION: Our data demonstrate that for the evaluation of effectiveness of PV ablation, the lack of symptoms during follow-up is not a valid indication. Objective rhythm monitoring in order to detect asymptomatic AF should be performed.