title: Post-discharge electrocardiogram Holter monitoring in recently hospitalised individuals with chronic atrial fibrillation to enhance therapeutic monitoring and identify potentially predictive phenotypes.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended rate or rhythm control following hospitalisation is a key therapeutic goal.
  
  
  OBJECTIVE
  The purpose of this study was to assess post-discharge maintenance of intended AF control and classify potentially predictive heart rate (HR) phenotypes via electrocardiogram (ECG) Holter monitoring.
  
  
  METHODS
  In a sub-study of a multicentre randomised controlled trial comparing AF-specific management with usual care, 24-hour ECG Holter monitoring was undertaken in 133 patients 7-14 days post-discharge. Intended rate and rhythm control were compared to Holter data. Analysis of the frequency distribution of mean hour-to-hour differences identified those with labile HRs.
  
  
  RESULTS
  Mean age was 71 ± 10 years, 67 (50%) were male and mean HR was 72 ± 14 bpm. Most (89%) had persistent AF (median time in AF=39% (IQR 0-100%)). Uncontrolled HR (>90 bpm for >10% of recording) occurred in 35 (26%) patients and 49 (37%) patients did not achieve their intended rate (n=26) or rhythm control (n=23). Patients in the upper quartile of mean hour-to-hour HR variability were identified as persistently labile (n=33). A further group (n=22) with periodically labile HRs was identified. Those with coronary artery disease (OR 0.34; 95% CI 0.13-0.91, p=0.033) or renal disease/dysfunction (OR 0.24; 95% CI 0.06-0.98, p=0.047) were less likely to demonstrate HR stability (n=78).
  
  
  CONCLUSIONS
  Post-discharge ECG Holter monitoring of AF patients represents a valuable tool to identify deviations in intended rhythm/rate control and adjust therapeutic management accordingly. It may also identify individuals who demonstrate labile HRs.
authors.affiliation: Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia Institute of Health, Australian Catholic University, Australia.
authors.forename: Jocasta
authors.initials: J
authors.lastname: Ball
authors.affiliation: Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia Institute of Health, Australian Catholic University, Australia.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.affiliation: Institute of Health, Australian Catholic University, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.affiliation: Bazil Hetzel Research Institute, The Queen Elizabeth Hospital, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
authors.affiliation: Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia Institute of Health, Australian Catholic University, Australia Simon.Stewart@bakeridi.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D002908:Chronic Disease; D003266:Continuity of Patient Care; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D010351:Patient Discharge; D010641:Phenotype; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Holter monitoring; disease management; risk delineation