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Electrophysiological characteristics associated with symptoms in pacemaker patients with paroxysmal atrial fibrillation

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Abstract

Purpose

The purpose of this study is to identify the electrophysiological factors affecting symptoms in paroxysmal atrial fibrillation (PAF) using patients with paroxysmal atrial fibrillation and pacemakers with advanced atrial fibrillation (AF) diagnostics.

Methods

Seventy-nine patients (age 71.0 ± 8.2, 54.4% male) with symptomatic PAF and AF burden of 1% to 50% with DDDRP pacemakers implanted were assessed for 6 months. Patients recorded symptom onset and duration and these were correlated with device-derived electrophysiological data.

Results

Of 2,638 AF episodes, 333 were symptomatic and 2,305 asymptomatic, with 194 non-atrial tachyarrhythmia symptomatic episodes giving a sensitivity of 12.6% and a positive predictive value of 63.2% for specific AF symptoms. Symptomatic AF episodes were 3.8 times more common diurnally than nocturnally (p < 0.001). Diurnally, symptomatic AF was significantly associated with a shorter AF cycle length (CL; p = 0.04), faster ventricular rate (p = 0.004), shorter PR interval (p < 0.001), faster preceding heart rate (p = 0.001) and increased early recurrence of AF (p < 0.04). Nocturnally, a significantly longer AF CL (p = 0.04) and PR interval (p < 0.001) prior to AF onset predicted symptomatic AF.

Conclusions

Symptoms in PAF are predicted by changes in AF episode duration, ventricular rate during AF, preceding sinus heart rate, AV nodal conduction and AF cycle length but not ventricular irregularity. Excess diurnal sympathetic tone and excess nocturnal vagal tone predispose to symptomatic PAF. These findings may have relevance for therapies for symptom control of PAF.

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Acknowledgements

We are grateful to Professor Nick Freemantle for his review of the statistical methodologies and software tools used in this analysis.

Funding

This work was supported by a research grant from Vitatron BV, Arnhem, The Netherlands.

Conflicts of interest

There are no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Eastbourne Hospital, East Sussex Hospitals NHS Trust, Kings Drive, Eastbourne, BN21 2UD, UK

    John Silberbauer, Rick A. Veasey, Nadeem Maddekar & Neil Sulke

  2. School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton, UK

    Elizabeth Cheek

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  1. John Silberbauer
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Correspondence to Neil Sulke.

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Silberbauer, J., Veasey, R.A., Cheek, E. et al. Electrophysiological characteristics associated with symptoms in pacemaker patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 26, 31–40 (2009). https://doi.org/10.1007/s10840-009-9411-x

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  • DOI: https://doi.org/10.1007/s10840-009-9411-x

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