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Frequent and Prolonged Asymptomatic Episodes of Paroxysmal Atrial Fibrillation Revealed by Automatic Long‐Term Event Recorders in Patients with a Negative 24‐Hour Holter
Author(s) -
ROCHE FRÉDÉRIC,
GASPOZ JEANMICHEL,
DA COSTA ANTOINE,
ISAAZ KARL,
DUVERNEY DAVID,
PICHOT VINCENT,
COSTES FRÉDÉRIC,
LACOUR JEANRENÉ,
BARTHÉLÉMY JEANCLAUDE
Publication year - 2002
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2002.01587.x
Subject(s) - medicine , asymptomatic , palpitations , holter monitor , atrial fibrillation , cardiology , prospective cohort study , cohort , paroxysmal supraventricular tachycardia , paroxysmal atrial fibrillation , anesthesia , electrocardiography , tachycardia
ROCHE, F., et al. : Frequent and Prolonged Asymptomatic Episodes of Paroxysmal Atrial Fibrillation Revealed by Automatic Long‐Term Event Recorders in Patients with a Negative 24‐Hour Holter. The presence, frequency, and duration of episodes of paroxysmal atrial fibrillation (PAF) is difficult to establish. This is caused by the limited duration of standard Holter recordings and to the unsatisfactory yield of patient‐triggered event recorders, because of asymptomatic events and of an inconsistent use of the patient dependent triggering function. A prospective cohort of 65 consecutive patients with recurrent palpitations and a negative 24‐hour ECG Holter was investigated by means of a cardiac event recorder bearing continuous automatic arrhythmia analysis and storage. Over a mean duration of 77 ± 36 hours, episodes of PAF were diagnosed in 20 (31%) patients, who had a total of 37 episodes; mean duration of PAF episodes was 7 hours 50 minutes ± 8/hours 45 minutes (minimum 45 minutes, maximum 28 hours). Eleven (55%) of these 20 patients were asymptomatic and would have remained undiagnosed without the automatic mode of the event recorder. Asymptomatic PAF episodes were longer than symptomatic ones (10 hours 30 minutes ± 6 hours 30 minutes vs 4 hours 50 minutes ± 4 hours, P < 0.05). In addition, episodes of sustained paroxysmal supraventricular tachycardia (PSVT) were diagnosed in 39 (57%) patients, of whom 34 (87%) were symptomatic. In this prospective cohort, a second standard 24‐hour monitoring would have missed 44% of the patients with PAF or PSVT and a classical patient‐triggered event recorder 13%. In patients still complaining of palpitations after one negative 24‐hour Holter, numerous, prolonged, and often asymptomatic episodes of PAF can be revealed by long‐term automatic event recorders. These devices should help clarify the clinical consequences of such episodes.