Key result
Continuous implantable monitoring detects asymptomatic AF recurrences over 48 hours in ~17% of optimally treated patients.
Why the study?
The long-term risk of undetected atrial fibrillation recurrence in patients receiving stable antiarrhythmic therapy remains uncertain.
Does continuous monitoring with an implantable device detect asymptomatic atrial fibrillation recurrences in patients with a history of AF on optimized antiarrhythmic therapy?
Observational (n=110)
Does continuous monitoring with an implantable device detect asymptomatic atrial fibrillation recurrences in patients with a history of AF on optimized antiarrhythmic therapy?
Continuous device monitoring reveals a high incidence of asymptomatic, long-lasting atrial fibrillation recurrences despite optimized antiarrhythmic therapy and apparent clinical freedom from AF.
Answers are grounded in this paper and cite their sources.
Do not infer AF freedom from symptoms or ECG; leaves open whether device-detected recurrences should change anticoagulation after apparent AAD success.
OBJECTIVES: The present study determined the incidence and time course of atrial fibrillation (AF) recurrences in patients with a history of AF and fitted with an implantable monitoring device. BACKGROUND: The long-term risk of undetected recurrence of AF in patients receiving stable antiarrhythmic therapy remains uncertain. METHODS: In 110 patients with a class I indication for physiologic pacing and a history of AF, a pacemaker with dedicated functions for AF detection and electrogram storage was implanted, and antiarrhythmic drug treatment was optimized. Patients were regularly followed up with evaluation of AF-related symptoms, a resting electrocardiogram (ECG), and interrogation of device memory. The incidence of AF recurrences lasting >48 h in asymptomatic patients presenting in sinus rhythm (SR) at the respective follow-up visit constituted the primary end point of this prospective study. RESULTS: During 19 +/- 11 months, 678 follow-up visits were performed. Atrial fibrillation was documented in 51 patients (46%) by ECG recording and in 97 patients (88%) by a review of stored electrograms (p < 0.0001). Device interrogation revealed AF recurrences lasting >48 h in 50 patients, 19 of whom (38%) were completely asymptomatic and in SR at subsequent follow-up. In 11 (16%) of 67 patients with device-confirmed freedom from AF for > or =3 months, AF lasting >48 h recurred subsequently. CONCLUSIONS: This prospective study demonstrates a high incidence of recurrent AF despite optimized antiarrhythmic therapy. Of particular note, AF relapses >48 h remained totally asymptomatic in a significant proportion of patients. Freedom from AF for > or =3 months did not preclude subsequent long-lasting AF recurrence.
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Israel et al. (2004) conducted an observational in History of atrial fibrillation and class I indication for physiologic pacing (n=110). Implantable monitoring device (pacemaker with AF detection) was evaluated on Incidence of AF recurrences lasting >48 h in asymptomatic patients presenting in sinus rhythm at follow-up. Continuous monitoring via an implantable device revealed asymptomatic atrial fibrillation recurrences lasting >48 hours in 17.3% of patients despite optimized antiarrhythmic therapy.
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