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CLINICAL STUDY

Treatment of underlying atrial fibrillation: paced rhythm obscures recognition

^a Department of Cardiac Electrophysiology, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA

Manuscript received July 29, 1999; revised manuscript received March 7, 2000, accepted April 14, 2000.

Reprint requests and correspondence: Dr. Howard I. Frumin, Division of Cardiology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073-6769

OBJECTIVES

The purpose of this study was to evaluate the rate of recognition of atrial fibrillation (AF), use of warfarin and prevalence of cerebrovascular accident (CVA) in paced versus unpaced patients during admission to a tertiary care teaching hospital.

BACKGROUND

The presence of AF underlying a continuously paced rhythm may be under recognized and result in a lower rate of anticoagulation and higher incidence of CVA.

METHODS

The identification of AF on 12 lead electrocardiogram (ECG) and telemetry, "optimal use" of anticoagulants that is, warfarin or aspirin, when warfarin is contraindicated and history of prior CVA was studied in three groups: 1) group A with continuously paced rhythm on ECG and telemetry (n = 30), 2) group B with intermittently paced rhythm on ECG and telemetry (n = 59), and 3) group C with persistent AF and no permanent pacemaker (n = 50).

RESULTS

The identification and documentation of AF was significantly lower in the continuously paced group A (20%) versus the intermittently paced group B (44%). Both groups A and B were substantially lower than unpaced controls. "Optimal use" of anticoagulants was significantly lower in group A (40%) compared with groups B (78%) and C (72%) but was not different between groups B and C. The prevalence of prior CVA was not significantly different between the three groups.

CONCLUSIONS

All ECGs in patients with paced rhythm should be examined closely for underlying AF to prevent under-recognition and under-treatment with anticoagulants.

Abbreviations and Acronyms   AF = atrial fibrillation   CVA = cerebrovascular accident   ECG = electrocardiogram   OHD = organic heart disease

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