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Incidence of Atrial Arrhythmias Detected by Permanent Pacemakers (PPM) Post‐Pulmonary Vein Antrum Isolation (PVAI) for Atrial Fibrillation (AF): Correlation with Symptomatic Recurrence
Author(s) -
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
Publication year - 2007
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2007.00789.x
Subject(s) - medicine , atrial fibrillation , pulmonary vein , cardiology , interquartile range , asymptomatic , antrum , incidence (geometry) , stomach , optics , physics
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.