Atrial tachyarrhythmias Toward optimizing detection and invasive treatment

Atrial tachyarrhythmias are the most common cardiac arrhythmias affecting millions of people worldwide. We investigated the detection and invasive ablation treatment of these heart rhythm disturbances and present the results in this thesis. In Part I, we validated an automated photoplethysmography atrial fibrillation (AF) detection algorithm. We found that this algorithm had excellent test characteristics to detect AF by omitting uncertain rhythm outcomes, with a corresponding sensitivity of 98.1% (95% CI 93.4 – 99.8) and specificity of 98.1% (95% CI 93.2 – 99.8%). In part II, we present the long-term outcome of cryoballoon ablation in patients with persistent AF, the efficacy of non-pulmonary vein (PV) target ablation in patients undergoing repeat AF ablation, and the additional value of mini electrodes in cavotricuspid isthmus ablation. The most important findings are i) 3.7 years after cryoballoon ablation, a substantial number of patients had an AF relapse. However, 80% of the patients improved in AF-related symptoms, and patients scored a high quality of life. ii) Non-PV target ablation did not improve arrhythmia free survival and was associated with a higher AT recurrence incidence. iii) The use of mini-electrodes in cavotricuspid isthmus ablation had additional value in only a small number of patients. In Part III of this thesis, we describe the safety outcomes of AF ablation using data from the Netherlands Heart Registration. The registered complication incidence of AF ablation was 3.6% and 30-day mortality was only 0.05%. We found that females had an increased risk of developing a cardiac tamponade, vascular complication, and phrenic nerve palsy.