Relationship between atrial tachyarrhythmias and symptoms.
OBJECTIVE
The purpose of this study was to correlate patient-reported symptoms of atrial fibrillation with the underlying rhythm.


BACKGROUND
The reliability of patient-reported symptoms as a marker of atrial fibrillation recurrence has not been well studied.


METHODS
This prospective multicenter trial correlated the recurrence of atrial tachyarrhythmias with symptoms in patients with a history of atrial fibrillation and a standard indication for permanent pacing. Pacemaker-detected atrial tachyarrhythmia events were correlated with symptoms. Patients logged symptomatic events into the device's memory via an external manual activator. Patients were followed for 12 months and were contacted weekly to ensure compliance with activator usage. Episodes were classified as symptomatic atrial tachyarrhythmia, asymptomatic atrial tachyarrhythmia, or symptomatic nonatrial tachyarrhythmia depending on concordance between patient symptoms and the rhythm.


RESULTS
Forty-eight patients underwent implantation of a DDDRP pacemaker and were followed for 12 +/- 2 months. A median of 25.0 (4.0-55.8) symptomatic events attributed to atrial fibrillation. A median of 1.0 (0.0-10.0) symptomatic atrial tachyarrhythmia episodes were documented during follow-up. Symptoms related to atrial fibrillation were reported in 6% of atrial tachyarrhythmia episodes identified by the pacemaker. The probability that symptoms were associated with an atrial tachyarrhythmia (positive predictive value) was 17%. The ventricular rate between symptomatic and asymptomatic atrial tachyarrhythmia events was not significantly different.


CONCLUSIONS
Among patients with symptomatic bradycardia and a history of atrial fibrillation, symptoms of atrial fibrillation often were not associated with documented atrial tachyarrhythmias, and more than 90% of atrial tachyarrhythmias were clinically silent.
Strickberger
S Adam
SA
Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA. strickberger@medstar.net
Ip
John
J
Saksena
Sanjeev
S
Curry
Ken
K
Bahnson
Tristram D
TD
Ziegler
Paul D
PD
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology*