Daily ECG transmission versus serial 6-day Holter ECG for the assessment of efficacy of ablation for atrial fibrillation — the AGNES-ECG study

PURPOSE: To compare daily ECG transmissions using trans-telephonic monitoring (TTM) with repeated 6-day Holter ECG in detecting atrial fibrillation (AF) episodes following ablation. METHODS: Each patient underwent two types of recordings: daily ECG TTM lasting 30 s and standard 6-day ambulatory ECG monitoring performed 3, 6, and 12 months after ablation. Number of patients with detected AF recurrences, time to first detected recurrence of AF, and AF burden were assessed. RESULTS: Fifty patients (9 females, mean age 57 ± 11 years) were included. The mean duration of the follow-up was 382 ± 38 days. A total of 17,573 (mean 351 ± 111 per patient) TTM recordings were performed and 99.95% of recordings were of quality sufficient to assess cardiac rhythm. Altogether, 14 (28%) patients had AF recurrence. Holter ECG detected AF recurrence in 7 (14%) patients whereas TTM — in 12 (24%) patients, p = 0.0416 (TTM only — 7 (14%), Holter ECG only — 2 (4%), and both methods — 5 (10%)). Time to the first AF recurrence tended to be shorter using TTM than Holter ECG (156 ± 91 vs 204 ± 121 days, p = 0.0819). There was no significant difference in AF burden assessed by TTM versus Holter ECG recordings 3.1 ± 0.14% vs 4.8 ± 0.2%, p = 0.21. CONCLUSIONS: Compared with Holter ECG, daily 30-s ECG recordings detected more patients with AF recurrences. Time to first detected AF episode tended to be shorter using TTM. Daily ECG recordings transmitted using smartphone may replace standard Holter ECG in detecting AF after ablation. TRIAL REGISTRATION: Clinical Trials Identifier: NCT03877913