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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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Abstract

Introduction

The temporal patterns of onset of persistent atrial fibrillation (AF) recurrences leading to established persistent AF is currently unknown.

Methods

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.

Results

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.

Conclusions

(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.

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Financial disclosure

Dr. Nagarakanti has no conflict of interest. Dr. Saksena is a consultant for Medtronic Inc., Sanofi-Aventis, and St. Jude Inc. and receives research support from Sorin Inc., the National Heart Lung and Blood Institute, and Sanofi-Aventis, Inc. Dr. Padeletti is a consultant for and receives research support from Medtronic Inc. and St. Jude Medical Italia. Dr. Douglas Hettrick, Ms. Jodi Koehler, and Dr. Andrea Grammatico are employees of Medtronic Inc. This study has been solely supported by the Electrophysiology Research Foundation without external funding.

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Authors and Affiliations

  1. Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA

    Rangadham Nagarakanti & Sanjeev Saksena

  2. UMDNJ—Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Sanjeev Saksena

  3. Medtronic Inc., Minneapolis, MN, USA

    Douglas Hettrick & Jodi L. Koehler

  4. Medtronic Inc., Milan, Italy

    Andrea Grammatico

  5. University of Florence, Florence, Italy

    Luigi Padeletti

Authors
  1. Rangadham Nagarakanti
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  2. Sanjeev Saksena
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  3. Douglas Hettrick
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  4. Jodi L. Koehler
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  5. Andrea Grammatico
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  6. Luigi Padeletti
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Correspondence to Sanjeev Saksena.

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Nagarakanti, R., Saksena, S., Hettrick, D. et al. Progression of new onset to established persistent atrial fibrillation: an implantable device-based analysis with implications for clinical classification of persistent atrial fibrillation. J Interv Card Electrophysiol 32, 7–15 (2011). https://doi.org/10.1007/s10840-011-9601-1

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  • DOI: https://doi.org/10.1007/s10840-011-9601-1

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