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J Am Coll Cardiol, 2004; 43:47-52, doi:10.1016/j.jacc.2003.08.027 © 2004 by the American College of Cardiology Foundation |
* J. W. Goethe University Hospital, Department of Medicine, Division of Cardiology, Frankfurt, Germany
Manuscript received June 17, 2003; revised manuscript received August 13, 2003, accepted August 26, 2003.
* Reprint requests and correspondence: Dr. Stefan H. Hohnloser, J. W. Goethe University, Department of Medicine, Division of Cardiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Hohnloser{at}em.uni-frankfurt.de
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 
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 3 months did not preclude subsequent long-lasting AF recurrence.
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