Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care.
OBJECTIVE
The present study determined the incidence and time course of atrial fibrillation (AF) recurrences in patients with a history of AF and fitted with an implantable monitoring device.


BACKGROUND
The long-term risk of undetected recurrence of AF in patients receiving stable antiarrhythmic therapy remains uncertain.


METHODS
In 110 patients with a class I indication for physiologic pacing and a history of AF, a pacemaker with dedicated functions for AF detection and electrogram storage was implanted, and antiarrhythmic drug treatment was optimized. Patients were regularly followed up with evaluation of AF-related symptoms, a resting electrocardiogram (ECG), and interrogation of device memory. The incidence of AF recurrences lasting >48 h in asymptomatic patients presenting in sinus rhythm (SR) at the respective follow-up visit constituted the primary end point of this prospective study.


RESULTS
During 19 +/- 11 months, 678 follow-up visits were performed. Atrial fibrillation was documented in 51 patients (46%) by ECG recording and in 97 patients (88%) by a review of stored electrograms (p < 0.0001). Device interrogation revealed AF recurrences lasting >48 h in 50 patients, 19 of whom (38%) were completely asymptomatic and in SR at subsequent follow-up. In 11 (16%) of 67 patients with device-confirmed freedom from AF for > or =3 months, AF lasting >48 h recurred subsequently.


CONCLUSIONS
This prospective study demonstrates a high incidence of recurrent AF despite optimized antiarrhythmic therapy. Of particular note, AF relapses >48 h remained totally asymptomatic in a significant proportion of patients. Freedom from AF for > or =3 months did not preclude subsequent long-lasting AF recurrence.
Israel
Carsten W
CW
J. W. Goethe University Hospital, Department of Medicine, Division of Cardiology, Frankfurt, Germany.
Grönefeld
Gerian
G
Ehrlich
Joachim R
JR
Li
Yi-Gang
YG
Hohnloser
Stefan H
SH
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D018670:Monitoring, Ambulatory; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors