학술논문
Brady- and tachyarrhythmias detected by continuous rhythm monitoring in paroxysmal atrial fibrillation
Document Type
Article
Author
Frausing, Maria Hee Jung Park; Van De Lande, Martijn E; Maass, Alexander H; Nguyen, Bao-Oanh; Hemels, Martin E W; Tieleman, Robert G; Koldenhof, Tim; De Melis, Mirko; Linz, Dominik; Schotten, Ulrich; Weberndo¨rfer, Vanessa; Crijns, Harry J G M; Van Gelder, Isabelle C; Nielsen, Jens Cosedis; Rienstra, Michiel
Source
Heart; 2023, Vol. 109 Issue: 17 p1286-1293, 8p
Subject
Language
ISSN
13556037; 1468201X
Abstract
ObjectiveAtrial fibrillation (AF) is associated with adverse events including conduction disturbances, ventricular arrhythmias and sudden death. The aim of this study was to examine brady- and tachyarrhythmias using continuous rhythm monitoring in patients with paroxysmal self-terminating AF (PAF).MethodsIn this multicentre observational substudy to the Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling and Vascular destabilisation in the progression of AF (RACE V), we included 392 patients with PAF and at least 2 years of continuous rhythm monitoring. All patients received an implantable loop recorder, and all detected episodes of tachycardia ≥182 beats per minute (BPM), bradycardia ≤30 BPM or pauses ≥5 s were adjudicated by three physicians.ResultsOver 1272 patient-years of continuous rhythm monitoring, we adjudicated 1940 episodes in 175 patients (45%): 106 (27%) patients experienced rapid AF or atrial flutter (AFL), pauses ≥5 s or bradycardias ≤30 BPM occurred in 47 (12%) patients and in 22 (6%) patients, we observed both episode types. No sustained ventricular tachycardias occurred. In the multivariable analysis, age >70 years (HR 2.3, 95% CI 1.4 to 3.9), longer PR interval (HR 1.9, 1.1–3.1), CHA2DS2-VASc score ≥2 (HR 2.2, 1.1–4.5) and treatment with verapamil or diltiazem (HR 0.4, 0.2–1.0) were significantly associated with bradyarrhythmia episodes. Age >70 years was associated with lower rates of tachyarrhythmias.ConclusionsIn a cohort exclusive to patients with PAF, almost half experienced severe bradyarrhythmias or AF/AFL with rapid ventricular rates. Our data highlight a higher than anticipated bradyarrhythmia risk in PAF.Trial registration numberNCT02726698.