title: Incidence of atrial arrhythmias detected by permanent pacemakers (PPM) post-pulmonary vein antrum isolation (PVAI) for atrial fibrillation (AF): correlation with symptomatic recurrence.
abstract: 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.
authors.affiliation: Cleveland Clinic Foundation, Section of Electrophysiology, Cleveland, Ohio 44195, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Stephen
authors.initials: S
authors.lastname: Minor
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Dhanumjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: S Claude
authors.initials: SC
authors.lastname: Elayi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cummings
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: 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