May 30, 2003Pacing and Clinical Electrophysiology
Immediate Reinitiation of Atrial Tachyarrhythmias after Spontaneous Restoration of Sinus Rhythm in Patients with an Implanted Monitoring Device
Population
68 patients with atrial tachyarrhythmias and bradycardia who received a pacemaker with dedicated memory…
Design
Cohort
Follow-up
1 month
Authors
Discussion
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Member takes
Implication
Frequent IRAT after spontaneous termination may warrant closer device monitoring; leaves open whether targeting short AT episodes prevents recurrence.
Key Points
- Investigate the incidence, electrophysiological characteristics, and clinical predictors of immediate reinitiation of atrial tachyarrhythmias following spontaneous restoration of sinus rhythm.
- Monitored patients with atrial tachyarrhythmias and bradycardia (N=68) using implanted pacemakers equipped with dedicated electrogram memory functions.
- Interrogated devices after 1 month to analyze 545 validated episodes across 36 patients for episode duration, pre-onset cycle length, and coupling intervals of initiating beats.
- Performed stepwise logistic regression analysis to determine independent clinical predictors of arrhythmia reinitiation.
- Immediate reinitiation of atrial tachyarrhythmia occurred in 212 of 545 episodes (39% across 24 patients) following spontaneous sinus rhythm restoration.
- Preceding tachyarrhythmia duration was longer (156 vs. 46 s, P < 0.001) and pre-onset atrial cycle length was shorter (775 ± 111 vs. 856 ± 133 ms, P < 0.001) in reinitiated episodes compared to non-reinitiated episodes.
- Coupling intervals of initiating atrial premature beats were significantly shorter before reinitiated episodes (502 ± 83 vs. 538 ± 89 ms, P < 0.001), while no clinical factors independently predicted reinitiation.
Structured PICO
P
Population
68 patients with atrial tachyarrhythmias (ATs) and bradycardia who received a pacemaker with dedicated memory functions (36 patients with 545 episodes analyzed)
I
Intervention
Implantation of a pacemaker with dedicated memory functions and interrogation after 1 month
O
Outcome
Incidence of immediate reinitiation of atrial tachyarrhythmia (IRAT) and characteristics of preceding episodes (duration, rate, sinus rate, coupling interval of APBs)surrogate
Immediate reinitiation of atrial tachyarrhythmia is frequent after spontaneous restoration of sinus rhythm, suggesting that electrophysiological changes promoting IRAT can develop even during short AT episodes.
Cite This Study
Israel et al. (2003) studied this question.