title: Mechanisms of onset of atrial fibrillation: a multicenter, prospective, pacemaker-based study.
abstract: The aim of this study was to analyze the onset mechanisms of atrial tachyarrhythmias using a dedicated diagnostic system in 83 recipients of DDDR pacemakers implanted for standard clinical indications. The pulse generator was programmed in DDD mode, at 60 beats/min, and the diagnostic instrument was programmed to document atrial tachyarrhythmic episodes at rates >200 beats/min. Onset mechanism was defined as the combination of ambient rhythm and trigger. Various underlying rates and rhythms patterns, including tachycardia, increasing frequency of premature atrial complex (PAC), underlying heart rate increase, restart, and no specific underlying rhythm, and various triggers, including single, multiple, or short runs of PACs, sudden rate decrease, and sudden onset of atrial tachyarrhythmia were included in the combined classification. Atrial tachyarrhythmic episodes were documented on one follow-up interrogation in 48 of the 83 patients. The pacing indications consisted of high degree atrioventricular block in 19 patients, bradycardia-tachycardia syndrome in 22, and isolated sinus node dysfunction in 6 patients. The onset mechanisms of 318 episodes were recorded and analyzed. A variety of triggers were observed in 33 of the 48 patients, and 39 patients had various ambient rhythms. Among 20 documented onset mechanisms, the most common were increasing frequency of PAC + short runs (17%), no specific ambient rhythm + sudden onset (24%), and increasing frequency of PAC + sudden onset (12%). There were wide intra- and interpatient variations in onset mechanisms, suggesting that state-of-the-art pacemakers should represent versatile diagnostic tools and offer flexible pacing methods to refine the management of atrial tachyarrhythmias.
authors.affiliation: Saint Philibert Hospital, Catholic Institute of Lille, Lille, France. Verdiere.Colette@ghicl.fupl.asso.fr
authors.forename: Yves
authors.initials: Y
authors.lastname: Guyomar
authors.forename: Olivier
authors.initials: O
authors.lastname: Thomas
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.forename: Moustapha
authors.initials: M
authors.lastname: Jarwe
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.forename: Roland
authors.initials: R
authors.lastname: Carlioz
authors.forename: Alain
authors.initials: A
authors.lastname: Ferrier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Fossati
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Guérin
authors.forename: Sébastien
authors.initials: S
authors.lastname: Heuls
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D014463:Ultrasonography