Abstract
BACKGROUND: Holter monitoring is widely used to detect atrial tachyarrhythmia (AT) recurrence after catheter ablation (CA) in patients with atrial fibrillation (AF). However, patients experience few subjective symptoms after CA, leading to potential underdiagnosis of recurrence. Two-week Holter monitoring may be more effective compared to 24-h Holter monitoring. This study aimed to evaluate the efficacy of 2-week Holter monitoring for the detection of AT recurrence. METHODS: From January 2019 to December 2021, 755 consecutive patients with AF (paroxysmal: 449, persistent: 256, long-standing: 50) who underwent initial CA with wide-area pulmonary vein isolation at our center were enrolled. Two-week Holter monitoring was conducted at 3, 6, 12, 18, and 24 months after CA. Twenty-four-hour Holter monitoring was substituted for the first 24 h of the 2-week Holter monitoring. Freedom from AT recurrence was defined as the absence of AT lasting > 30 s beyond a 3-month blanking period. RESULTS: Sixty-nine (9.1%) patients dropped out. Among the remaining 686 patients, AT recurrence was detected over the 2-year follow-up period in 173 cases (25.2%) using 2-week Holter monitoring and in 46 cases (6.7%) using 24-h Holter monitoring (p < 0.001). Holter monitoring-based analysis revealed that asymptomatic recurrence was significantly more common in patients with persistent and long-standing AF (85.0%, 96/113 records) compared to those with paroxysmal AF (50.0%, 76/152 records) (p < 0.001). CONCLUSION: Two-week Holter monitoring was significantly more effective than conventional 24-h Holter monitoring for detecting AT recurrence after CA, particularly in patients with persistent and long-standing AF.