Supraventricular Tachycardia Burden on Ambulatory ECG Monitoring Predicts Recurrent Atrial Fibrillation Following Catheter Ablation for Atrial Fibrillation.

This study aims to evaluate the predictive value of supraventricular tachycardia (SVT) detected on 7-14-day ambulatory electrocardiogram (AECG) monitoring for atrial fibrillation (AF) recurrence following catheter ablation (CA) for AF. A retrospective analysis of patients who underwent CA for AF between 2015 and 2023 and underwent AECG monitoring within 1 year after CA was performed. The data in this study was extracted from electronic health records. Receiver operating characteristic (ROC) curve analysis was used to identify optimal SVT thresholds predictive of AF recurrence. Three SVT parameters were analyzed: total number of SVT episodes, average number of episodes per day, and % e of monitored days with SVT. Multivariable Cox regression models adjusted for age, sex, comorbidities, AF type, cardioversion history, and prior SVT were used to estimate hazard ratios (HRs) for AF recurrence. Adjusted Kaplan-Meier curves and log-rank tests were utilized to assess AF-free survival. Of 1,245 patients monitored with AECG, 573 (46.02%) experienced AF recurrence, with 232 (40.48%) undergoing AECG prior to AF recurrence. These patients were compared to 672 (53.97%) patients without recurrence. Patients with recurrence were more often female and had a higher comorbidity burden (p <0.05). Non-sustained (<30s) and sustained (≥30s) SVT episodes were significantly associated with increased risk for recurrence (HR 2.56 and 3.03, respectively; P=0.01). A total SVT count ≥15, ≥5 episodes/day, and SVT on ≥85% of monitored days also independently predicted AF recurrence (p=0.002). In conclusion, a high SVT burden on 7- to 14-day AECG post-ablation is a strong, independent predictor of AF recurrence and may help guide post-procedural risk stratification and monitoring strategies.