title: Immediate reinitiation of atrial tachyarrhythmias after spontaneous restoration of sinus rhythm in patients with an implanted monitoring device.
abstract: Immediate reinitiation of atrial tachyarrhythmia (IRAT) has been observed after cardioversion. After spontaneous restoration of sinus rhythm (SR), incidence and characteristics of IRAT have not been described. Therefore, in patients with atrial tachyarrhythmias (ATs) and bradycardia, a pacemaker with dedicated memory functions was implanted. Devices were interrogated after 1 month and stored episodes of AT were analyzed: incidence of IRAT, duration and rate of the preceding episode, sinus rate before AT, coupling interval of atrial premature beats (APBs) initiating AT, and incidence of repetitive APBs. A potential association with IRAT was assessed for clinical characteristics. In 36 of 68 patients, stored electrograms confirmed correct detection of AT onset and termination in 545 episodes. IRAT was present in 212 (39%, 24 patients) episodes of AT. Episodes of AT preceding IRAT were longer than those before non-IRAT (156 vs 46 s, P < 0.001), and occurred during a higher atrial rate before onset of AT (cycle length 775 +/- 111 vs 856 +/- 133 ms, P < 0.001). The coupling interval of APBs initiating IRAT was shorter (502 +/- 83 vs 538 +/- 89 ms; P < 0.001) while the percentage of episodes with repetitive APBs before AT onset and the median atrial cycle length of the preceding AT were not different. On stepwise logistic regression analysis, none of the clinical factors evaluated independently predicted IRAT. In conclusion, IRAT is frequent after spontaneous restoration of SR. Changes of atrial electrophysiological properties promoting IRAT may already develop during AT of short duration.
authors.affiliation: J. W. Goethe University, Division of Cardiology, Frankfurt, Germany.
authors.forename: Carsten W
authors.initials: CW
authors.lastname: Israel
authors.forename: Joachim R
authors.initials: JR
authors.lastname: Ehrlich
authors.forename: Gerian
authors.initials: G
authors.lastname: Grönefeld
authors.forename: Yi-Gang
authors.initials: YG
authors.lastname: Li
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012008:Recurrence; D013610:Tachycardia / Q000175:diagnosis* / Q000503:physiopathology