Dynamic Data-Driven Management of Atrial Fibrillation With Implantable Cardiac Monitors: The MONITOR AF Study.

Background: Implantable cardiac monitors (ICMs) provide valuable insights into managing atrial fibrillation (AF). Data suggest that ICMs increase AF detection, but their impact on management is still uncertain.

Objectives: To evaluate and compare the impact of ICMs on the clinical management of AF.

Methods: MONITOR-AF (NCT06352060) was a retrospective, multi-center study of patients with AF between 2018 to 2021 who received an ICM or routine monitoring with electrocardiograms or long-term monitoring. Patients were followed for 12 months, making note of AF-related clinical outcomes.

Results: There were 2293 patients who received an ICM (n=1115) or routine monitoring (n=1178). Although comorbidities between ICM and non-ICM were significantly different, none of the AF-related characteristics were significantly different. Patients in the ICM group had more attempts at rhythm control with AAD (100% vs. 59.9%, p<0.001) and CA (91.7% vs. 59.7%, p<0.001). This led to higher freedom from AF at 12 months (86.0% vs. 61.8%, p<0.001) and freedom from anti-arrhythmic drugs (75.9% vs. 39.4%, p<0.001) and oral anticoagulation (69.6.8% vs. 39.4%, p<0.001) usage, and was associated with reduced rates of stroke (0.3% vs. 1.6%, p<0.001) and major bleeding (1.6% vs. 2.9%, p<0.001).

Conclusions: Dynamic monitoring with ICM is associated with beneficial AF outcomes with improved freedom from AF at 12 months and fewer complications. Thus, ICM use should be considered for the management of chronic AF.