Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care |
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Authors: | Israel Carsten W Grönefeld Gerian Ehrlich Joachim R Li Yi-Gang Hohnloser Stefan H |
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Affiliation: | J. W. Goethe University Hospital, Department of Medicine, Division of Cardiology, Frankfurt, Germany. |
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Abstract: | 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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