Elsevier

Heart Rhythm

Volume 2, Issue 2, February 2005, Pages 125-131
Heart Rhythm

Relationship between atrial tachyarrhythmias and symptoms

https://doi.org/10.1016/j.hrthm.2004.10.042Get rights and content

Objectives

The purpose of this study was to correlate patient-reported symptoms of atrial fibrillation with the underlying rhythm.

Background

The reliability of patient-reported symptoms as a marker of atrial fibrillation recurrence has not been well studied.

Methods

This prospective multicenter trial correlated the recurrence of atrial tachyarrhythmias with symptoms in patients with a history of atrial fibrillation and a standard indication for permanent pacing. Pacemaker-detected atrial tachyarrhythmia events were correlated with symptoms. Patients logged symptomatic events into the device’s memory via an external manual activator. Patients were followed for 12 months and were contacted weekly to ensure compliance with activator usage. Episodes were classified as symptomatic atrial tachyarrhythmia, asymptomatic atrial tachyarrhythmia, or symptomatic nonatrial tachyarrhythmia depending on concordance between patient symptoms and the rhythm.

Results

Forty-eight patients underwent implantation of a DDDRP pacemaker and were followed for 12 ± 2 months. A median of 25.0 (4.0–55.8) symptomatic events attributed to atrial fibrillation. A median of 1.0 (0.0–10.0) symptomatic atrial tachyarrhythmia episodes were documented during follow-up. Symptoms related to atrial fibrillation were reported in 6% of atrial tachyarrhythmia episodes identified by the pacemaker. The probability that symptoms were associated with an atrial tachyarrhythmia (positive predictive value) was 17%. The ventricular rate between symptomatic and asymptomatic atrial tachyarrhythmia events was not significantly different.

Conclusions

Among patients with symptomatic bradycardia and a history of atrial fibrillation, symptoms of atrial fibrillation often were not associated with documented atrial tachyarrhythmias, and more than 90% of atrial tachyarrhythmias were clinically silent.

Section snippets

Study design

The study utilized a multicenter, randomized, single-blind parallel study design. Patient inclusion criteria included an American College of Cardiology/American Heart Association (ACC/AHA) class I or II indication for dual-chamber pacing,2 a history of atrial fibrillation within the past year, and no more than one cardioversion in the prior year. Patients with permanent or persistent atrial fibrillation, an indication for an implantable defibrillator, New York Heart Association (NYHA) class III

Patient characteristics

Table 1 summarizes patient demographic data, which were similar between patients randomized to the prevention and termination algorithms programmed either on or off. Among the 48 patients enrolled in the study, 45 completed the study. The data from these 45 patients are used for the analyses. Two patients died during the study.

The median device-stored atrial tachyarrhythmia burden was similar between patients randomized to have the prevention and termination algorithms programmed on or off (

Major findings

The major finding of this study is that in patients with symptomatic bradycardia, a history of atrial fibrillation, and an indication for permanent pacing, symptoms perceived to be related to atrial fibrillation often are not associated with an atrial tachyarrhythmia. In this study, almost 95% of documented atrial tachyarrhythmia episodes were asymptomatic, and symptoms attributed to atrial fibrillation were associated with atrial tachyarrhythmias only approximately 15% of the time.

References (11)

There are more references available in the full text version of this article.

Cited by (158)

  • Atrial fibrillation, cancer and anticancer drugs

    2023, Archives of Cardiovascular Diseases
  • Healthy Sleep Patterns and Risk of Incident Arrhythmias

    2021, Journal of the American College of Cardiology
View all citing articles on Scopus

This study was supported in part by a research grant from Medtronic, Inc., Minneapolis, Minnesota. Paul D. Ziegler is an employee of Medtronic. Dr. Bahnson is a co-investigator for Medtronic. Dr. Strickberger receives research grants and unrestricted gifts, consults for, and occasionally is a paid speaker for Medtronic. Dr. Saksena receives consulting fees, royalties, and other remuneration from Medtronic.

View full text