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Circulation, Vol 89, 224-227, Copyright © 1994 by American Heart Association
RL Page, WE Wilkinson, WK Clair, EA McCarthy and EL Pritchett
BACKGROUND: Paroxysmal atrial fibrillation and paroxysmal supraventricular
tachycardia are recognized clinically when patients seek treatment for
symptoms due to recurrent arrhythmias; atrial fibrillation also increases
the risk of stroke. The frequency with which asymptomatic arrhythmias occur
in patients with these arrhythmias is unknown. METHODS AND RESULTS:
Twenty-two patients with paroxysmal atrial fibrillation (n = 8) or
paroxysmal supraventricular tachycardia (n = 14) were studied for 29 days
with two different ambulatory ECG- monitoring techniques to measure the
relative frequency of asymptomatic and symptomatic arrhythmias. All class I
antiarrhythmic drugs, calcium channel blockers, beta-blockers, and
digitalis were withheld. Sustained asymptomatic arrhythmia events (defined
as lasting at least 30 seconds) were documented using continuous ambulatory
ECG monitoring once weekly for a total of 5 of the 29 study days;
symptomatic arrhythmia events were documented using transtelephonic ECG
monitoring for all 29 days of the study. In the group of patients with
paroxysmal atrial fibrillation, asymptomatic arrhythmia events occurred
significantly more frequently than symptomatic arrhythmia events; the mean
rates, expressed as events/100 d/patient (95% confidence interval), were
62.5 (40.4, 87.3) and 5.2 (2.7, 9.0) (P < .01); the ratio of the mean
rates was 12.1 (5.8, 26.4). In contrast, in the group of patients with
paroxysmal supraventricular tachycardia, asymptomatic arrhythmia events
were significantly less frequent than symptomatic arrhythmia events; the
mean rates were 0.0 (0.0, 5.3) and 7.4 (5.0, 10.6) (P = .02). The ratio of
the mean rates was 0.0 (0.0, 0.8). CONCLUSIONS: In a group of patients with
paroxysmal atrial fibrillation, sustained asymptomatic atrial fibrillation
occurs far more frequently than symptomatic atrial fibrillation. However,
it is not known whether asymptomatic atrial fibrillation is a potential
risk factor for stroke even when patients are not having symptomatic
arrhythmias.
ARTICLES
Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia
Department of Medicine, Duke University Medical Center, Durham, NC.
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F. D. Murgatroyd, S. M. Gibson, X. Baiyan, S. O'Nunain, J. D. Poloniecki, D. E. Ward, M. Malik, and A. J. Camm Double-Blind Placebo-Controlled Trial of Digoxin in Symptomatic Paroxysmal Atrial Fibrillation Circulation, June 1, 1999; 99(21): 2765 - 2770. [Abstract] [Full Text] [PDF]
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F. Anselme, N. Saoudi, H. Poty, R. Douillet, and A. Cribier Radiofrequency Catheter Ablation of Common Atrial Flutter : Significance of Palpitations and Quality-of-Life Evaluation in Patients With Proven Isthmus Block Circulation, February 2, 1999; 99(4): 534 - 540. [Abstract] [Full Text] [PDF]
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J.A. Goudevenos, J.N. Vakalis, V. Giogiakas, P. Lathridou, C. Katsouras, L.K. Michalis, and D.A. Sideris An epidemiological study of symptomatic paroxysmal atrial fibrillation in northwest Greece Europace, January 1, 1999; 1(4): 226 - 233. [Abstract] [PDF]
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M. Rosenqvist, T. Beyer, M. Block, K. den Dulk, J. Minten, and F. Lindemans Adverse Events With Transvenous Implantable Cardioverter-Defibrillators : A Prospective Multicenter Study Circulation, August 18, 1998; 98(7): 663 - 670. [Abstract] [Full Text] [PDF]
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H. Paydak, J. G. Kall, M. C. Burke, D. Rubenstein, D. E. Kopp, R. J. Verdino, and D. J. Wilber Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter : Time to Onset, Determinants, and Clinical Course Circulation, July 28, 1998; 98(4): 315 - 322. [Abstract] [Full Text] [PDF]
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B. M. Psaty, T. A. Manolio, L. H. Kuller, R. A. Kronmal, M. Cushman, L. P. Fried, R. White, C. D. Furberg, and P. M. Rautaharju Incidence of and Risk Factors for Atrial Fibrillation in Older Adults Circulation, October 7, 1997; 96(7): 2455 - 2461. [Abstract] [Full Text]
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L. B. Goldstein, A. Farmer, and D. B. Matchar Primary Care Physician–Reported Secondary and Tertiary Stroke Prevention Practices : A Comparison Between the United States and the United Kingdom Stroke, April 1, 1997; 28(4): 746 - 751. [Abstract] [Full Text]
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E. N. Prystowsky, D. W. Benson Jr, V. Fuster, R. G. Hart, G. N. Kay, R. J. Myerburg, G. V. Naccarelli, and D. G. Wyse Management of Patients With Atrial Fibrillation : A Statement for Healthcare Professionals From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association Circulation, March 15, 1996; 93(6): 1262 - 1277. [Full Text]
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A. P. Aboaf and P. S. Wolf Paroxysmal Atrial Fibrillation: A Common but Neglected Entity Arch Intern Med, February 26, 1996; 156(4): 362 - 367. [Abstract] [PDF]
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F. Philippon, V. J. Plumb, A. E. Epstein, and G. N. Kay The Risk of Atrial Fibrillation Following Radiofrequency Catheter Ablation of Atrial Flutter Circulation, August 1, 1995; 92(3): 430 - 435. [Abstract] [Full Text]
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