title: Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care.
abstract: 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.
authors.affiliation: J. W. Goethe University Hospital, Department of Medicine, Division of Cardiology, Frankfurt, Germany.
authors.forename: Carsten W
authors.initials: CW
authors.lastname: Israel
authors.forename: Gerian
authors.initials: G
authors.lastname: Grönefeld
authors.forename: Joachim R
authors.initials: JR
authors.lastname: Ehrlich
authors.forename: Yi-Gang
authors.initials: YG
authors.lastname: Li
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
mesh_terms: 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