Comparative Efficacy of Continuous Versus Patch ECG Monitoring in Detecting Atrial Fibrillation Recurrence Post Catheter Ablation: Insights From the REAL‐AF Registry

ABSTRACT Background Effective monitoring of atrial fibrillation (AF) recurrence following catheter ablation is crucial for optimizing patient outcomes. Various monitoring strategies exist, but effectiveness comparisons remain underexplored. Objective This study compares the recurrence of atrial arrhythmias detected by continuous versus patch ECG monitoring methods following radiofrequency ablation (RFA) for AF. Methods Real‐world data from the REAL‐AF Registry (NCT 04088071) were analyzed. REAL‐AF is a prospective, observational, multicenter registry and this analysis included patients with available 12‐month follow‐up post‐RFA. We compared the detected recurrence rates of all‐atrial arrhythmias from continuous monitoring insertable cardiac monitors (ICMs), dual‐chamber pacemakers, and implantable cardioverter defibrillator (ICDs) or from patch ECG monitoring for 7–14‐days. Results Out of 2263 patients, 688 (30.4%) were monitored continuously, and 1575 (69.6%) were monitored with patch ECGs. The detected recurrence rate of all atrial arrhythmias was significantly higher in the continuous monitoring group compared to the patch monitoring group at 12 months (28.1% and 13.5%, p < 0.001, respectively). This difference remained significant after adjusting for confounding factors such as age, type of AF, CHA 2 DS 2 ‐VASc score, and left ventricular ejection fraction (HR = 0.44, 95% CI [0.35, 0.56], p < 0.001). Conclusion Continuous monitoring is associated with a higher detection rate of atrial arrhythmia recurrences following AF catheter ablation. These findings suggest that continuous monitoring should be considered the standard of care, especially in evaluating new ablation strategies and technologies.