Background: Definition of success after atrial fibrillation (AF) ablation is a matter of debate in the last years and is highly dependent on the intensity of monitoring. Continuous cardiac monitoring has the advantage to register arrhythmic events irrespective of symptoms and allows the assessment of AF burden, a parameter that has been shown to have a prognostic significance after ablation. We aim to determine the long-term success after AF ablation using implantable loop recorders (ILR). 

Methods: In this prospective registry, a total of 126 consecutive patients (63 ± 10 years, 77 males) with paroxysmal (49%) or persistent AF (51%), who became an implantable loop recorder (ILR) following AF ablation were included. Telemedicine staff evaluated automatic arrhythmia episodes and AF burden every 3 months during 3 years of follow-up. Conventional definition of success was freedom from any atrial arrhythmia recurrence >30sec. 

Results: Using a conventional definition, 36%, 29% and 32% of patients were free from arrhythmia after 1, 2 and 3 years respectively. The mean AF burden was 2.99%, 3.14% and 2.53% after 1,2 and 3 years respectively. An AF burden <1% was documented in 66% at the first year, 63% at the second year, and 65% of patients at the third year(Figure 1).

Conclusions: Continuous AF monitoring over a follow-up of 3 years provides important information. About a third of patients remains free from any atrial arrhythmia recurrence after AF ablation and success rate remains stable over the years. AF burden is mostly low in patients with recurrence, bringing into question the meaningful definition of success after ablation.