Abstract 10793: Duration of Rhythm Monitoring and Arrhythmia Recurrence After Pulmonary Vein Isolation for Atrial Fibrillation: A Systematic Review and Meta-Regression Study
Bibliographic record
Abstract
Introduction: The effect of the rhythm monitoring strategy after catheter ablation for atrial fibrillation (AF) on reported atrial arrhythmia (AA) recurrence is not well characterized. We aimed to determine whether continuous rhythm monitoring after AF ablation detects more AA recurrence than intermittent rhythm monitoring, and whether the total duration of intermittent rhythm monitoring predicts reported AA recurrence. Methods: EMBASE, MEDLINE, and CENTRAL databases were systematically searched for randomized controlled trials (RCT) of adult patients undergoing first catheter ablation for AF from 2007 to 2019. Studies with a minimum of 12 months follow-up were included. We selected trial arms of patients undergoing first-time ablation for AF using pulmonary vein isolation alone, without additional left-sided ablation lesion sets. Studies of surgical and hybrid ablation, or those without full rhythm monitoring details were excluded. Duration of rhythm monitoring was extracted and summed in duplicate. Meta-regression with random effects and mixed-effects models was used to identify any association between duration of monitoring and single-procedure AA recurrence. Analyses were performed separately on arms of patients with paroxysmal AF, and persistent AF (PeAF) or combined PAF/PeAF. Results: The search strategy and study selection yielded 47 trial arms from 46 RCTs comprising 4236 patients: 30 arms of patients with PAF and 17 arms of patients with PeAF or both PAF/PeAF. There was less AA recurrence in arms undergoing intermittent monitoring than continuous monitoring in PAF arms (31.1% vs. 44.4%, p < 0.01), but not in PeAF/ PAF-PeAF combined arms (47.1% vs. 63.6%, p=0.22). There was no significant relationship between the duration of intermittent rhythm monitoring and AA recurrence in both PAF (p=0.87) and PeAF/ PAF-PeAF combined arms (p=0.14). Conclusions: In RCTs of catheter ablation for PAF, continuous rhythm monitoring detected higher AA recurrence rates than intermittent rhythm monitoring. The duration of intermittent rhythm monitoring did not influence reported AA recurrence. These findings have important implications to the care of patients with AF and to researchers studying AF ablation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.051 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.030 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".