Journal of cardiovascular electrophysiology · 2007
Incidence of atrial arrhythmias detected by permanent pacemakers (PPM) post-pulmonary vein antrum isolation (PVAI) for atrial fibrillation (AF): correlation with symptomatic recurrence.
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Verma Atul, Minor Stephen, Kilicaslan Fethi, Patel Dimpi, Hao Steven, Beheiry Salwa, Lakkireddy Dhanumjaya, Elayi S Claude, Cummings Jennifer, Martin David O, Burkhardt J David, Schweikert Robert A, Saliba Walid, Tchou Patrick J, Natale Andrea
Аннотация
BACKGROUND: Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known.
OBJECTIVE: To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence.
METHODS: Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range).
RESULTS: The patients (age 57 +/- 8 years, EF 54 +/- 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4-256] vs 401 [151-2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857-1,390]) and sustained (18 +/- 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%).
CONCLUSIONS: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.
OBJECTIVE: To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence.
METHODS: Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range).
RESULTS: The patients (age 57 +/- 8 years, EF 54 +/- 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4-256] vs 401 [151-2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857-1,390]) and sustained (18 +/- 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%).
CONCLUSIONS: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.