Findings from a new clinical trial support use of implantable cardiac monitors (ICM) as a standard of care in managing patients with complex cardiac arrhythmias like atrial fibrillation (AF). The study will be presented today as a late-breaking clinical trial at Heart Rhythm 2023.
While conventional monitoring happens intermittently, ICMs allow physicians to continuously monitor AF burden in a dynamic way outside of a clinical setting. The MONITOR AF study included a multi-institutional prospective registry that sought to assess how dynamic monitoring of arrhythmias, like AF, can help inform patient care decisions and improve access to care.
The study enrolled patients with and without ICMs and measured the difference in various aspects of AF management including access to care, time to initiation and change of antiarrhythmic drugs, and time to ablation.
A total of 2,458 AF patients were enrolled in the study (ICM group: 1,152, non-ICM group: 1,306). Patients with pacemakers and implantable defibrillators, ICMs for cryptogenic stroke, and those who had AF ablation prior to enrolment were excluded. The mean age was 73±12 vs. 74±10, p=0.78 (Males 65±5 vs. 62±6, p=0.56; paroxysmal AF 68±5 vs. 65±6, p=0.34).
During a mean follow up of 24 months—the median time to antiarrhythmic drug therapy (AAD) start (36 vs 46 days), time to first ablation (5 vs 14 months), number of external monitors used (0 vs 4) and time to redo ablation (73 vs 165 days) were significantly better in the ICM than the non-ICM group.
“AF is a chronic disease that requires long-term monitoring, yet the tools used today to measure the success of interventions are limited. Our goal was to better understand how ICMs can help provide improved symptom control and overall clinical decision making,” said Dhanunjaya Lakkireddy (Kansas City Heart Rhythm Institute at HCA Midwest Health, Kansas City, USA). “Like we have seen with diabetes management, care guided by real-time data aided by improved technology rather than point-in-time assessments allows more precise, individualised AF patient management. We believe results show how dynamic monitoring can improve access to care, early intervention and ongoing decision making to result in better patient outcomes.”