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


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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

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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

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