心房細動アブレーション後の負担に基づく転帰：4年間の連続モニタリング研究

Atrial fibrillation (AF) markedly impairs quality of life and increases healthcare burden. Long-term outcomes of catheter ablation (CA) using continuous rhythm monitoring remain under-characterized.

To assess atrial tachyarrhythmia burden (ATaB) using implantable cardiac monitors (ICMs) before and up to 4 years after CA, and to examine the association between ATaB reduction and quality of life (QoL). In an exploratory proof-of-concept analysis we evaluated whether simulated intermittent monitoring (Burden-by-Sampling, BBS) can approximate ICM-derived ATaB.

In this single-centre, prospective cohort, 165 patients with paroxysmal or persistent AF underwent first-time CA after pre-ablation ICM insertion. ATaB (percentage time in AF/atrial tachycardia) was continuously recorded for up to 4 years. Annual QoL assessments used the SF-36 and an AF-specific symptom questionnaire. Retrospective BBS simulation sampled ICM data at varying frequencies to explore intermittent monitoring performance.

Median follow-up was 40.9 months. Median ATaB declined from 15% [0-100] to 0% [0-22.5] (p<0.001). In the recurrence subgroup (n=76), ATaB decreased from 93% to 0.45% [0.09-8.2] (p<0.001); >90% of patients achieved ≥75% reduction. QoL improved significantly at 1 year and remained stable, although physical SF-36 scores were not consistently significant beyond 1 year. BBS performance improved with increased sampling frequency but remains exploratory.

CA produces a durable, substantial reduction in ATaB over 4 years, with sustained QoL benefit. These findings challenge binary definitions of ablation success and support burden-based, patient-centred endpoints. Exploratory BBS simulations suggest potential for intermittent monitoring but require prospective validation.