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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAtrial fibrillation (AF) is responsible for substantial morbidity, including stroke. While catheter ablation has emerged as an effective treatment for symptomatic AF [Stabile G et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2006], less is known about the incidence of either pre- or postablation asymptomatic AF [Rho RW, Page RL. \u003Cem\u003EProg Cardiovasc Dis\u003C\/em\u003E 2005]. This article discusses results from the Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation trial [DISCERN AF; Verma A et al. \u003Cem\u003EJAMA Intern Med\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is responsible for substantial morbidity, including stroke. While catheter ablation has emerged as an effective treatment for symptomatic AF [Stabile G et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2006], less is known about the incidence of either pre- or postablation asymptomatic AF [Rho RW, Page RL. \u003Cem\u003EProg Cardiovasc Dis\u003C\/em\u003E 2005]. Because clinical outcomes related to the use of ablation for AF typically rely on a patient\u0027s symptoms, it is likely that asymptomatic AF has important implications on postablation outcomes and treatments.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAtul Verma, MD, Southlake Regional Health Center, Newmarket, Ontario, Canada, spoke about results from the Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation trial [DISCERN AF; Verma A et al. \u003Cem\u003EJAMA Intern Med\u003C\/em\u003E 2013]. The purpose of the trial was to monitor the incidence and predictors of symptomatic versus asymptomatic AF in patients who had undergone catheter ablation, according to an implantable cardiac monitor (ICM) with an implantable loop recorder that automatically recorded episodes of AF. The device was implanted at least 3 months before the patient underwent ablation and was in place for a minimum of 18 months following ablation.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDISCERN AF was a multicenter prospective cohort study conducted at 8 centers across Canada. Enrollment began in November 2008 and included 50 patients. Baseline characteristics are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. The primary end points of the study were incidence of asymptomatic AF versus (1) symptomatic AF before ablation, (2) symptomatic AF recurrence following \u201csuccessful\u201d ablation, and (3) symptomatic AF recurrence following \u201cunsuccessful\u201d ablation. Successful ablation was defined as a lack of AF episodes \u0026gt;2 minutes at least 3 months after ablation.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14823\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14823\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14823\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EPatient Characteristics: DISCERN, n=50 AF\u003Csup\u003E*\u003C\/sup\u003E\n            \u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EThe first follow-up after implantation of the device occurred at 3 months to collect preablation data, then every 3 months for 18 months after ablation. At each visit, data from the ICM were downloaded and saved, and patients\u0027 symptoms diaries were collected. Patients were blinded to the ICM data; the physicians were not, as they needed the information to aid in clinical decision making. Episodes of AF were classified by independent adjudicators as AF, atrial flutter (AFL), atrial tachycardia (AT), sinus, sinus with ectopy, or artifact. Symptomatic recurrence was defined as an ICM-recorded episode of atrial arrhythmia for which there were symptoms recorded by the patient in the diary. All other episodes were considered asymptomatic.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Verma then reviewed the results from DISCERN AF. From a total of 2355 of AF episodes recorded by the ICM, 69% were true AF, AFL, and AT. Following ablation, the total AF, AFL, and AT burden was reduced by 86%, from a mean of 2 hours per day per patient to 0.3 hours per day (p\u0026lt;0.001); 56% of all episodes were asymptomatic. The ratio of asymptomatic AF, AFL, and AT significantly increased after ablation from 1.1 to 3.7 (p=0.002).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EMultivariate predictors of asymptomatic AF included postablation status, lower heart rate, lower heart rate variability, and a shorter duration of episode. Prof. Verma concluded by emphasizing that symptoms alone likely underestimate the AF burden after ablation, as 12% of patients had exclusively asymptomatic episodes of recurrent arrhythmia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/21\/24.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp0m1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp0m1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}