Progression of new onset to established persistent atrial fibrillation: an implantable device-based analysis with implications for clinical classification of persistent atrial fibrillation
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The temporal patterns of onset of persistent atrial fibrillation (AF) recurrences leading to established persistent AF is currently unknown.
Three hundred thirty patients with a history of paroxysmal AF and bradycardia (mean age, 70 ± 10 years; 61% male) with implanted pacemakers that automatically recorded the cumulative daily atrial tachyarrhythmia (AT) burden were included in the analysis. Persistent AF was defined as device data showing ≥7 consecutive days with ≥23 h of AT. We analyzed the pattern and duration of persistent AF recurrences and time to each persistent AF episode recurrence.
Seventy-eight patients (24%) developed their first persistent AT/AF after 147 ± 149 days. Follow up ranged from 14 to 499 days. Median AF burden in the week prior to persistent AF was 3.5 h/day. Fifty-four patients (16%) had a minimum of 180 days follow up after initial detection of persistent AF. Three of 54 patients (6%) immediately developed established AF; 32 of 51 patients (63%) returned to sinus rhythm but then had a second persistent AF event. These 32 patients had a minimum of 90 days follow up and 25 of these 32 patients (78 %) had a third persistent AF event. Time to recurrence analysis showed progressive abbreviation in persistent AF onset. The median durations of the first, second, and third persistent AF events were 16, 13, and 17 days, respectively.
(1) The time to first, second, and third persistent AF recurrences progressively decreases with a high likelihood of established persistent AF within 9 months of onset. (2) These data support intermittent but frequent AF monitoring for the detection of persistent AF recurrences to assess the efficacy of rhythm control interventions.
KeywordsAtrial fibrillation Cardiac pacemakers Arrhythmia Device monitoring
- 1.Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA, 285, 2370–2375.PubMedCrossRefGoogle Scholar
- 2.Miyasaka, Y., Barnes, M. E., Gersh, B. J., Cha, S. S., Bailey, K. R., Abhayaratna, W. P., et al. (2006). Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114, 119–125.PubMedCrossRefGoogle Scholar
- 3.Camm, A. J., Kirchhof, P., Lip, G. Y., Schotten, U., Savelieva, I., Ernst, S., et al. (2010). Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology. Europace, 12(10), 1360–1420.PubMedCrossRefGoogle Scholar
- 9.Levy, S., Camm, A. J., Saksena, S., Breithardt, C. H. J., Davies, D. W., Kay, G. N., et al. (2003). International consensus on nomenclature and classification of atrial fibrillation: a collaborative project of the Working Group on Arrhythmias and the Working Group of Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Journal of Cardiovascular Electrophysiology, 14, 443–445.PubMedCrossRefGoogle Scholar
- 10.Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S. A., Crijns, H. J., et al. (2007). HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation developed in partnership with the European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Society (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS). Heart Rhythm, 4(6), 816–861.PubMedCrossRefGoogle Scholar
- 12.Padeletti, L., Pürerfellner, H., Adler, S. W., Waller, T. J., Harvey, M., Horvitz, L., et al. (2003). Combined efficacy of atrial septal lead placement and atrial pacing algorithms for prevention of paroxysmal atrial tachyarrhythmia. Journal of Cardiovascular Electrophysiology, 14, 1189–1195.PubMedCrossRefGoogle Scholar
- 14.Inama, G., Santini, M., Padeletti, L., Boriani, G., Botto, G., Capucci, A., et al. (2004). Far-field R wave oversensing in dual chamber pacemakers designed for atrial arrhythmia management: effect of pacing site and lead tip to ring distance. Pacing and Clinical Electrophysiology, 27, 1221–1230.PubMedCrossRefGoogle Scholar
- 15.Israel, C. W., Gronefeld, G., Ehrlich, J. R., Li, Y. G., & Hohnloser, S. H. (2004). Long-term risk of recurrent atrial fibrillation as documented by implantable monitoring device: implications for optimal patient care. Journal of the American College of Cardiology, 43, 47–52.PubMedCrossRefGoogle Scholar
- 17.Willems, R., Wyse, D. G., Gillis, A. M., & for the Atrial Pacing Periablation for Paroxysmal Atrial Fibrillation (PA3) Study Investigators. (2003). Total atrioventricular nodal ablation increases atrial fibrillation burden in patients with paroxysmal atrial fibrillation despite continuation of antiarrhythmic drug therapy. Journal of Cardiovascular Electrophysiology, 14, 1296–1301.PubMedCrossRefGoogle Scholar
- 19.Saksena, S., & Skadsberg, N. (2008). Three-dimensional and biatrial mapping of atrial tachyarrhythmias in coronary and hypertensive heart disease: identifying mechanisms that initiate and maintain atrial fibrillation. Journal American Colleg Cardiology (Abstract), 51(10 Suppl A), A5.Google Scholar
- 20.Glotzer, T. V., Daoud, E. G., Wyse, D. G., Singer, D. E., Ezekowitz, M. D., Hilker, C., et al. (2009). The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circulation Arrhythmia and Electrophysiology, 2(5), 474.PubMedCrossRefGoogle Scholar
- 21.Pedersen, O. D., Bagger, H., Keller, N., Marchant, B., Køber, L., Torp-Pedersen, C., et al. (2001). Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigations of arrhythmia and mortality on dofetilide (diamond) substudy. Circulation, 104, 292–296.PubMedGoogle Scholar
- 22.Deedwania, P. C., Singh, B. N., Ellenbogen, K., Fisher, S., Fletcher, R., & Singh, S. N. (1998). Patients with heart failure and atrial fibrillation: observations from the Veterans Affairs Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF-STAT). Circulation, 98, 2574–2579.PubMedGoogle Scholar