Prof Dominik Linz opens this webinar by introducing the faculty: Patrick Badertcher, James Rosengarten, and Mintu Turakhia. This introduction also features a poll to gauge routine practice for arrhythmia monitoring in post-PVI patients, offering various options from symptom-driven monitoring to serial patch ECGs and wearable devices. And finally, Prof Linz recaps the first two webinars in this series to bring the audience up to speed.

Prof Patrick Badertscher uses two real-world cases to highlight the challenges of rhythm monitoring post-AF ablation, demonstrating that patient symptoms are unreliable. He reviews data from the CircaDose trial, which revealed that reported ablation success rates depend heavily on monitoring intensity.

Key findings show that short-term ECGs (below 7 days) miss about 50% of true AF recurrences. Furthermore, 14-day monitoring provided the best correlation with continuous implantable loop recorder data for AF burden estimation. Prof Badertscher summarises the ERA-HRS consensus, which recommends a minimum of 24-hour Holter ECGs every three months in the first year, but prefers 7- or 14-day monitoring for higher sensitivity, aiming for 28 days total monitoring per year. He concludes that prolonged, structured monitoring redefines ablation success.

Dr James Rosengarten uses a case study on post-stroke management to illustrate the value of extended cardiac monitoring. He highlights the unreliability of a standard 7-day ECG, as his patient's significant AF episode (one hour 40 minutes) was detected on day nine of a 14-day ZioPatch monitoring period.

He presents data showing that in a 14-day monitoring population, 15% of arrhythmia detection occurred after the seven-day mark. Dr Rosengarten discusses studies confirming that longer monitoring significantly increases AF detection in all stroke patients.

He notes that the most recent ACC practical consensus guidance recommends a minimum of 14 days of monitoring post-stroke. Given cost and resource considerations, he prioritises the 14-day patch ahead of an implantable loop recorder as the first investigative step, concluding that extended wear patch monitoring is a highly acceptable option for all stroke patients.

Dr Mintu Turakhia discusses the clinical challenges of device selection for ambulatory cardiac monitoring, highlighting a lack of consensus on treatment thresholds, such as whether to use AF burden or longest episode. He emphasises the value of continuous, long-term monitoring, showing that the benefits of arrhythmia detection extend through days 8–14.

Dr Turakhia notes that short monitoring periods may incorrectly classify a patient as having persistent AF, while the longer monitoring time of the Amalfi study demonstrated that patients tolerate extended wear well. He stresses that not all AI is equal, noting significant differences in AF detection accuracy between various patches. He concludes that clinicians need high-quality devices that provide accurate AI and comprehensive metrics like AF burden, longest episode, and topic counts to inform individualised patient discussions.

This final session addressed key clinical challenges, beginning with Dr Turakhia advising that unexpected arrhythmias, such as NSVT, require evaluation of cardiac structure and function. The panel clarified that the low-burden AF recurrences missed by 14-day monitoring post-ablation are typically insignificant to management. Dr Rosengarten noted that the implantable loop recorder (ILR) is reserved for truly cryptogenic, recurrent stroke cases, with the 14-day patch as the preferred first step. Finally, the panel confirmed that despite the use of AI, all high-quality reports are ultimately confirmed by trained human technicians.