Post-PVAI, atrial tachyarrhythmias were detected by permanent pacemakers in 32% of patients without symptomatic AF recurrence, though sustained asymptomatic episodes were uncommon (3%).
Cohort (n=86)
p-value: p=<0.01
BACKGROUND: Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known. OBJECTIVE: To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence. METHODS: Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range). RESULTS: The patients (age 57 +/- 8 years, EF 54 +/- 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 4-256 vs 401 151-2,470, P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 857-1,390) and sustained (18 +/- 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%). CONCLUSIONS: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.
Verma et al. (Wed,) conducted a cohort in Atrial Fibrillation (n=86). Pulmonary Vein Antrum Isolation (PVAI) was evaluated on Incidence of atrial tachycardia/fibrillation post-PVAI detected by PPM and correlation to symptomatic recurrence (p=<0.01). Post-PVAI, atrial tachyarrhythmias were detected by permanent pacemakers in 32% of patients without symptomatic AF recurrence, though sustained asymptomatic episodes were uncommon (3%).
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