Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care

doi:10.1016/j.jacc.2003.08.027

HOME

QUICK SEARCH:

	Author:		Keyword(s):
Year:		Vol:		Page:

J Am Coll Cardiol, 2004; 43:47-52, doi:10.1016/j.jacc.2003.08.027
© 2004 by the American College of Cardiology Foundation

This Article

	Figures Only
	Full Text
	Full Text (PDF)
	Alert me when this article is cited
	Alert me if a correction is posted

Services

	Email this article to a friend
	Similar articles in this journal
	Similar articles in PubMed
	Alert me to new issues of the journal
	Download to citation manager

Citing Articles

	Citing Articles via HighWire
	Citing Articles via Google Scholar

Google Scholar

	Articles by Israel, C. W.
	Articles by Hohnloser, S. H.
	Search for Related Content

PubMed

	PubMed Citation
	Articles by Israel, C. W.
	Articles by Hohnloser, S. H.

CLINICAL RESEARCH: ELECTROPHYSIOLOGY

Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device

Implications for optimal patient care

Carsten W. Israel, MD^*, Gerian Grönefeld, MD^*, Joachim R. Ehrlich, MD^*, Yi-Gang Li, MD^* and Stefan H. Hohnloser, MD, FACC, FESC^*^,*

^* 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 ofatrial fibrillation (AF) recurrences in patients with a historyof AF and fitted with an implantable monitoring device.

BACKGROUND: The long-term risk of undetected recurrence of AF in patientsreceiving stable antiarrhythmic therapy remains uncertain.

METHODS: In 110 patients with a class I indication for physiologic pacingand a history of AF, a pacemaker with dedicated functions forAF detection and electrogram storage was implanted, and antiarrhythmicdrug treatment was optimized. Patients were regularly followedup with evaluation of AF-related symptoms, a resting electrocardiogram(ECG), and interrogation of device memory. The incidence ofAF recurrences lasting >48 h in asymptomatic patients presentingin sinus rhythm (SR) at the respective follow-up visit constitutedthe 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 ECGrecording and in 97 patients (88%) by a review of stored electrograms(p < 0.0001). Device interrogation revealed AF recurrenceslasting >48 h in 50 patients, 19 of whom (38%) were completelyasymptomatic 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 recurrentAF despite optimized antiarrhythmic therapy. Of particular note,AF relapses >48 h remained totally asymptomatic in a significantproportion of patients. Freedom from AF for $≥$ 3 months did notpreclude subsequent long-lasting AF recurrence.

Abbreviations and Acronyms
  AF = atrial fibrillation
  AV = atrioventricular
  ECG = electrocardiogram/electrocardiographic
  SR = sinus rhythm

This article has been cited by other articles:

S. Knecht, M. D. O'Neill, T. Verbeet, D. Roy, M. Talajic, and S. Nattel
Rhythm Control versus Rate Control for Atrial Fibrillation
N. Engl. J. Med., October 2, 2008; 359(14): 1522 - 1522.
[Full Text] [PDF]

S. H. Hohnloser, G. Z. Duray, U. Baber, and J. L. Halperin
Prevention of stroke in patients with atrial fibrillation: current strategies and future directions
Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H4 - H10.
[Abstract] [Full Text] [PDF]

A. J. Camm and J. A. Reiffel
Defining endpoints in clinical trials on atrial fibrillation
Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H55 - H78.
[Abstract] [Full Text] [PDF]

C. W. Israel
Effect of statins in 'upstream therapy' of atrial fibrillation: better reliability with implantable cardiac monitors
Eur. Heart J., August 1, 2008; 29(15): 1798 - 1799.
[Full Text] [PDF]

J. R. Edgerton, Z. J. Edgerton, T. Weaver, K. Reed, S. Prince, M. A. Herbert, and M. J. Mack
Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation.
Ann. Thorac. Surg., July 1, 2008; 86(1): 35 - 39.
[Abstract] [Full Text] [PDF]

S. R Majumdar
Oral bisphosphonates and atrial fibrillation
BMJ, April 12, 2008; 336(7648): 784 - 785.
[Full Text] [PDF]

R. Nieuwlaat, T. Dinh, S. B. Olsson, A. J. Camm, A. Capucci, R. G. Tieleman, G. Y.H. Lip, H. J.G.M. Crijns, and on behalf of the Euro Heart Survey Investigators
Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?
Eur. Heart J., April 1, 2008; 29(7): 915 - 922.
[Abstract] [Full Text] [PDF]

M. E.W. Hemels, J. H. Ruiter, G. P. Molhoek, N. J.G.M. Veeger, A. C.P. Wiesfeld, A. V. Ranchor, M. van Trigt, A. Pilmeyer, I. C. Van Gelder, and for The Features in AT500TM study; Chances for pat
Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study
Europace, March 1, 2008; 10(3): 306 - 313.
[Abstract] [Full Text] [PDF]

R. P. Ricci, L. Morichelli, and M. Santini
Home monitoring remote control of pacemaker and implantable cardioverter defibrillator patients in clinical practice: impact on medical management and health-care resource utilization
Europace, February 1, 2008; 10(2): 164 - 170.
[Abstract] [Full Text] [PDF]

F. G. Cosio, E. Aliot, G. L. Botto, H. Heidbuchel, C. J. Geller, P. Kirchhof, J.-C. De Haro, R. Frank, J. P. Villacastin, J. Vijgen, et al.
Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode
Europace, January 1, 2008; 10(1): 21 - 27.
[Abstract] [Full Text] [PDF]

C. W. Israel
Studying atrial fibrillation: what can we learn from the AFTherapy study?
Europace, December 1, 2007; 9(12): 1107 - 1109.
[Full Text] [PDF]

R. Nieuwlaat, L. W. Eurlings, A. Capucci, and H. J.G.M. Crijns
Atrial fibrillation in the 'real world': undecided issues
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I122 - I128.
[Abstract] [Full Text] [PDF]

P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al.
Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA)
Eur. Heart J., November 2, 2007; 28(22): 2803 - 2817.
[Abstract] [Full Text] [PDF]

P. Kirchhof, A. Auricchio, J. Bax, H. Crijns, J. Camm, H.-C. Diener, A. Goette, G. Hindricks, S. Hohnloser, L. Kappenberger, et al.
Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association
Europace, November 1, 2007; 9(11): 1006 - 1023.
[Abstract] [Full Text] [PDF]

M. Budeus, M. Hennersdorf, O. Felix, K. Reimert, C. Perings, H. Wieneke, R. Erbel, and S. Sack
Prediction of atrial fibrillation in patients with cardiac dysfunctions: P wave signal-averaged ECG and chemoreflexsensitivity in atrial fibrillation
Europace, August 1, 2007; 9(8): 601 - 607.
[Abstract] [Full Text] [PDF]

S. B. Rowan, D. N. Bailey, C. E. Bublitz, and R. J. Anderson
Trends in Anticoagulation for Atrial Fibrillation in the U.S.: An Analysis of the National Ambulatory Medical Care Survey Database
J. Am. Coll. Cardiol., April 10, 2007; 49(14): 1561 - 1565.
[Abstract] [Full Text] [PDF]

J. Heeringa, D. A. M. van der Kuip, A. Hofman, J. A. Kors, F. J. A. van Rooij, G. Y. H. Lip, and J. C. M. Witteman
Subclinical Atherosclerosis and Risk of Atrial Fibrillation: The Rotterdam Study
Arch Intern Med, February 26, 2007; 167(4): 382 - 387.
[Abstract] [Full Text] [PDF]

R. Nieuwlaat, A. Capucci, G. Y.H. Lip, S. B. Olsson, M. H. Prins, F. H. Nieman, J. Lopez-Sendon, P. E. Vardas, E. Aliot, M. Santini, et al.
Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation
Eur. Heart J., December 2, 2006; 27(24): 3018 - 3026.
[Abstract] [Full Text] [PDF]

W. G. de Voogt, N. M. van Hemel, A. A. van de Bos, J. Koistinen, and J. H. Fast
Verification of pacemaker automatic mode switching for the detection of atrial fibrillation and atrial tachycardia with Holter recording.
Europace, November 1, 2006; 8(11): 950 - 961.
[Abstract] [Full Text] [PDF]

I. C. Van Gelder and M. E.W. Hemels
The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm
Europace, November 1, 2006; 8(11): 943 - 949.
[Abstract] [Full Text] [PDF]

D. G. Wyse
Transvenous Radiofrequency Catheter Ablation for Atrial Flutter and Atrial Fibrillation: The End of the Beginning?
Circulation, October 17, 2006; 114(16): 1670 - 1672.
[Full Text] [PDF]

Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace, September 1, 2006; 8(9): 651 - 745.
[Full Text] [PDF]

V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906.
[Full Text] [PDF]

V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246.
[Full Text] [PDF]

V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation, August 15, 2006; 114(7): e257 - e354.
[Full Text] [PDF]

V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al.
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society
Circulation, August 15, 2006; 114(7): 700 - 752.
[Full Text] [PDF]

Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al.
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030.
[Full Text] [PDF]

J. Heeringa, D. A.M. van der Kuip, A. Hofman, J. A. Kors, G. van Herpen, B. H.Ch. Stricker, T. Stijnen, G. Y.H. Lip, and J. C.M. Witteman
Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study
Eur. Heart J., April 2, 2006; 27(8): 949 - 953.
[Abstract] [Full Text] [PDF]

A. M. Gillinov, J. Sirak, E. H. Blackstone, P. M. McCarthy, J. Rajeswaran, G. Pettersson, F. J. Sabik III, L. G. Svensson, J. L. Navia, D. M. Cosgrove, et al.
The Cox maze procedure in mitral valve disease: Predictors of recurrent atrial fibrillation
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1653 - 1660.
[Abstract] [Full Text] [PDF]

T. M. Sundt and B. J. Gersh
Making Sense of the Maze: Which Patients With Atrial Fibrillation Will Benefit?
JAMA, November 9, 2005; 294(18): 2357 - 2359.
[Full Text] [PDF]

B. J. Padanilam and E. N. Prystowsky
Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position
Circulation, August 23, 2005; 112(8): 1223 - 1231.
[Full Text] [PDF]

G. Hindricks, C. Piorkowski, H. Tanner, R. Kobza, J.-H. Gerds-Li, C. Carbucicchio, and H. Kottkamp
Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence
Circulation, July 19, 2005; 112(3): 307 - 313.
[Abstract] [Full Text] [PDF]

D. J. Callans
Comparing Different Strategies for Catheter Ablation of Atrial Fibrillation
Circulation, June 7, 2005; 111(22): 2866 - 2868.
[Full Text] [PDF]

M. R. Karch, B. Zrenner, I. Deisenhofer, J. Schreieck, G. Ndrepepa, J. Dong, K. Lamprecht, P. Barthel, E. Luciani, A. Schomig, et al.
Freedom From Atrial Tachyarrhythmias After Catheter Ablation of Atrial Fibrillation: A Randomized Comparison Between 2 Current Ablation Strategies
Circulation, June 7, 2005; 111(22): 2875 - 2880.
[Abstract] [Full Text] [PDF]

D. G. Sherman, S. G. Kim, B. S. Boop, S. D. Corley, J. P. DiMarco, R. G. Hart, L. J. Haywood, K. Hoyte, E. S. Kaufman, M. H. Kim, et al.
Occurrence and Characteristics of Stroke Events in the Atrial Fibrillation Follow-up Investigation of Sinus Rhythm Management (AFFIRM) Study
Arch Intern Med, May 23, 2005; 165(10): 1185 - 1191.
[Abstract] [Full Text] [PDF]

B. J. Gersh, T. S.M. Tsang, M. E. Barnes, and J. B. Seward
The changing epidemiology of non-valvular atrial fibrillation: the role of novel risk factors
Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C5 - C11.
[Abstract] [Full Text] [PDF]

G. C. Gronefeld, S. H. Hohnloser, S. H. Konety, B. Olshansky, A. K. Wittkowsky, P. Alboni, G. I. Botto, and N. Baldi
The "Pill-in-the-Pocket" Approach to Atrial Fibrillation
N. Engl. J. Med., March 17, 2005; 352(11): 1150 - 1151.
[Full Text] [PDF]

G. Senatore, G. Stabile, E. Bertaglia, G. Donnici, A. De Simone, F. Zoppo, P. Turco, P. Pascotto, and M. Fazzari
Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation
J. Am. Coll. Cardiol., March 15, 2005; 45(6): 873 - 876.
[Abstract] [Full Text] [PDF]

R. L. Page
Newly Diagnosed Atrial Fibrillation
N. Engl. J. Med., December 2, 2004; 351(23): 2408 - 2416.
[Full Text] [PDF]

A A J Adgey and S J Walsh
Theory and practice of defibrillation: (1) Atrial fibrillation and DC conversion
Heart, December 1, 2004; 90(12): 1493 - 1498.
[Full Text] [PDF]

A. Pacifico and P. D. Henry
Ablation for atrial fibrillation: are cures really achieved?
J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1940 - 1942.
[Abstract] [Full Text] [PDF]

How Common Is Asymptomatic Afib?
Journal Watch Cardiology, March 12, 2004; 2004(312): 2 - 2.
[Full Text]