Diagnosis of paroxysmal atrial fibrillation in patients with implanted pacemakers: relationship to symptoms and other variables.
BACKGROUND
Atrial fibrillation (AF) is not always accompanied by clear-cut symptoms and symptoms suggestive of AF may not correspond to a genuine AF episode. The study prospectively evaluated the burden of asymptomatic AF episodes in pacemaker patients (for sick sinus syndrome) with a history of documented paroxysmal AF.


METHODS
Consecutive patients were enrolled and implanted with dual-chamber pacemakers equipped with diagnostic features for AF monitoring. Each patient was instructed about typical AF symptoms and was asked to keep a detailed log of symptoms. Stored pacemaker data were analyzed using only AF episodes >30 s.


RESULTS
The mean follow-up was 16 +/- 6 months and 102 patients were enrolled (73 +/- 7 years, 59 M). Thirteen patients (13%) dropped out with the development of permanent AF and their data were discarded. Twenty-three patients (26%) without device-stored AF episodes all reported at least one annotated AF episode. There were 1,245 device-stored AF episodes in 66 (74%) out of 89 patients. Patients reported 1,141 episodes of AF-related symptoms. Only 240 (21%) corresponded to a genuine device-stored AF event. The sensitivity and positive predictive value of symptoms to detect AF were respectively 19% and 21%. Episode duration, rate increase at the onset of the arrhythmia, heart disease, or antiarrhythmic drug therapy showed no statistically significant differences comparing symptomatic and asymptomatic episodes.


CONCLUSIONS
Many pacemaker patients with paroxysmal AF can develop AF-like symptoms in the absence of device-stored AF. AF-related symptoms have low sensitivity and low positive predictive value in patients with permanent pacemakers.
Quirino
Gianluca
G
Ivrea Hospital, Ivrea, Italy. giorgio.corbucci@medtronic.com
Giammaria
Massimo
M
Corbucci
Giorgio
G
Pistelli
Paolo
P
Turri
Elena
E
Mazza
Antonio
A
Perucca
Antonello
A
Checchinato
Catia
C
Dalmasso
Maurizio
M
Barold
S Serge
SS
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors