Key result
Continuous pacemaker monitoring demonstrated that mean AF burden rose 0.34% per year (P<0.0001), with patients exhibiting distinct patterns such as non-progressive, progressive, and relapsing AF.
Why the study?
What are the long-term patterns of atrial fibrillation progression in patients with dual chamber permanent pacemakers?
Cohort (n=323)
What are the long-term patterns of atrial fibrillation progression in patients with dual chamber permanent pacemakers?
p-value: p=< 0.0001
Objective pacemaker diagnostics reveal that AF progression is complex, with distinct subtypes including non-progressive, relapsing-remitting, and persistent forms that can revert to paroxysmal AF.
Pacemaker monitoring reveals heterogeneous AF progression with remission possible; leaves open whether subtype recognition refines risk stratification or therapy.
AIMS: To describe the long-term patterns of atrial fibrillation (AF) in patients with permanent pacemakers. METHODS AND RESULTS: A total of 2092 pacemaker Holter downloads were analysed in 323 patients with dual chamber permanent pacemakers, describing a cumulative 1031 patient-years of beat-to-beat monitoring. Four subtypes of AF were applied: (i) non-progressive low-burden PAF (NPLB-PAF, n = 120): such patients never have >1% AF burden throughout follow-up; (ii) chronic progressive PAF (CP-PAF, n = 55): AF burden increases but is never 100%; (iii) relapsing-remitting PAF (RR-PAF, n = 78): AF burden has reduced at least once by more than 2% and is never 100%; (iv) persistent AF (PersAF, n = 70): 100% AF burden for at least 28 days. Overall, mean AF burden rose 0.34% per year (P < 0.0001). After accounting for age, heart failure (HF) had a significant interaction with AF burden (P = 0.0022), but HATCH score and CVA/TIA did not. There were no differences in the frequency or duration of monitoring between the four AF subtypes. Atrial fibrillation episode frequency discriminated between subtypes (P = 0.0004). Eighteen of 70 (26%) patients with PersAF had pacemaker documented episodes of sinus rhythm (i.e. reversion to 'paroxysmal AF') after the onset of PersAF. CONCLUSION: In this cohort, the development of AF over time appears more complex than current definitions suggest. Atrial fibrillation can remain low burden without progression, remit-relapse, or progress as is described in currently accepted definitions. More frequent episodes of AF indicated a favourable subtype. Persistent AF is not inevitable, and can revert to paroxysmal AF. CLINICAL TRIAL REGISTRATION: NCT02016950, http://clinicaltrials.gov/show/NCT02016950.
No takes yet. Share an insight, caveat, or question.
Sugihara et al. (2015) conducted a cohort in Atrial fibrillation in patients with permanent pacemakers (n=323). Continuous beat-to-beat monitoring via dual chamber permanent pacemakers was evaluated on Mean AF burden change per year (p=< 0.0001). Continuous pacemaker monitoring demonstrated that mean AF burden rose 0.34% per year (P<0.0001), with patients exhibiting distinct patterns such as non-progressive, progressive, and relapsing AF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: