Incidence of atrial arrhythmias detected by permanent pacemakers (PPM) post-pulmonary vein antrum isolation (PVAI) for atrial fibrillation (AF): correlation with symptomatic recurrence.
BACKGROUND
Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known.


OBJECTIVE
To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence.


METHODS
Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range).


RESULTS
The patients (age 57 +/- 8 years, EF 54 +/- 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4-256] vs 401 [151-2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857-1,390]) and sustained (18 +/- 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%).


CONCLUSIONS
Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.
Verma
Atul
A
Cleveland Clinic Foundation, Section of Electrophysiology, Cleveland, Ohio 44195, USA.
Minor
Stephen
S
Kilicaslan
Fethi
F
Patel
Dimpi
D
Hao
Steven
S
Beheiry
Salwa
S
Lakkireddy
Dhanumjaya
D
Elayi
S Claude
SC
Cummings
Jennifer
J
Martin
David O
DO
Burkhardt
J David
JD
Schweikert
Robert A
RA
Saliba
Walid
W
Tchou
Patrick J
PJ
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010138:Pacemaker, Artificial; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D014481:United States / Q000453:epidemiology