Monitoring

For a patient with persistent atrial fibrillation (AF) that is felt to be secondary to a reversible cause, once that cause has been removed, long-term follow-up may not be necessary after the initial treatment and evaluation of the AF. For a patient requiring continued therapy due to the assessment of risk of recurrence, follow-up should include the following general categories:

  • Adequate treatment of the associated medical/cardiac diagnosis

  • Periodic assessments of efficacy of therapy

  • Periodic evaluation for the adverse effects or complications of therapy

  • Maintenance and monitoring of adequate anticoagulation

  • Re-evaluation of the current therapy if the underlying cardiovascular problem changes or progresses or the AF becomes permanent.

During initiation of medical therapy, it is important to monitor symptoms and the link between symptoms and heart rhythm and rate.[79] This can be challenging when the events are infrequent or unpredictable, but mobile health devices can increase AF detection compared with standard practice (e.g., wearable mobile devices, 24-hour Holter).[79] Several rating scales are available for monitoring symptoms, e.g. the Symptom Checklist Frequency and Severity Scale, Atrial Fibrillation Effect on Quality of Life, and the University of Toronto Atrial Fibrillation Severity Scale, although some are limited in terms of validity testing or symptom coverage.[79]

As some patients with AF have asymptomatic recurrences irrespective of the therapy (antiarrhythmic drug or ablation), anticoagulation should be considered long term. Evaluation of AF burden with a Holter monitor, event monitor, pacemaker or implantable cardiac defibrillator, or insertable loop monitor can be considered if the patient is symptomatic. This is largely to ensure that ventricular rates are controlled if persistent AF progresses to permanent AF or the amount and duration of AF episodes change. Any change in the clinical status of a patient with a history of AF should prompt the physician to look for a recurrence as the cause of the clinical change.

It is reasonable to monitor cardiac function by transthoracic echocardiograms every 3-6 months in patients treated with a rate control strategy to assess for the development of AF-related tachycardia-induced cardiomyopathy.

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