The future of long-term monitoring following catheter and surgical intervention for atrial fibrillation

Monitoring following catheter or surgical ablation for atrial fibrillation (AF) is an essential tool used to assess outcomes for research purposes and help guide clinical decision making. The most commonly used methods to monitor for postintervention AF include a variety of ambulatory external electrocardiogram monitors, cardiac implantable electronic devices, and more recently, direct to consumer digital health technologies. The traditional metric of ablation success, recurrence > 30 s at 1 year, is below the detection capabilities of almost all monitoring techniques yet still undervalues the efficacy of AF interventions. Measures of AF burden reduction and duration give a more complete assessment of the impact of AF surgeries and ablation. As it is increasingly being recognized that AF burden and duration is related to stroke risk, long-term, inexpensive, noninvasive monitoring methods are needed. Smart phones and watches with AF-detecting capabilities, which are increasingly being used by the majority of U.S. adults, have emerged as viable options to achieve this goal, shifting the paradigm of AF monitoring to a more patient-centered approach.