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Cited by 315Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.

Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF): A Prospective, Multicenter Study

Verma, Atul, Champagne, Jean, Sapp, John, Essebag, Vidal, Novak, Paul, Skanes, Allan, Morillo, Carlos A., Khaykin, Yaariv, Birnie, David·2013·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2013.1561
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Abstract

BACKGROUND: The DISCERN AF study (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) monitored atrial fibrillation (AF) using an implantable cardiac monitor (ICM) to assess the incidence and predictors of asymptomatic AF before and after catheter ablation. METHODS: Patients with symptomatic AF underwent implantation of an ICM with an automated AF detection algorithm 3 months before and 18 months after ablation. Patients kept a standardized diary to record symptoms of arrhythmia, and ICM data were downloaded every 3 months. All episodes were blindly adjudicated and correlated with the diary. Asymptomatic recurrences were ICM episodes of 2 minutes or longer with no associated diary symptoms. RESULTS: Fifty patients had 2355 ICM episodes. Of these, 69.0% were true AF/atrial flutter (AFL)/atrial tachycardia (AT); 16.0%, sinus with extrasystoles; 11.0%, artifact; and 4.0%, sinus arrhythmia. Total AF/AFL/AT burden was reduced by 86% from a mean (SD) of 2.0 (0.5) h/d per patient before to 0.3 (0.2) h/d per patient after ablation (P < .001), and 56.0% of all episodes were asymptomatic. The ratio of asymptomatic to symptomatic AF episodes increased after ablation from 1.1 to 3.7 (P = .002). By symptoms alone, 29 of 50 patients (58%) were free of AF/AFL/AT after ablation compared with 23 of 50 (46%) using ICM-detected AF/AFL/AT recurrence. Asymptomatic episodes were more likely AFL/AT and were significantly shorter and slower, with lower heart rate variability. However, the postablation state was the strongest independent predictor of asymptomatic AF. CONCLUSIONS: The ratio of asymptomatic to symptomatic AF episodes increased from 1.1 before to 3.7 after ablation. Postablation state is the strongest predictor of asymptomatic AF. Symptoms alone underestimate postablation AF burden, with 12% of patients having asymptomatic recurrences only. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00745706.

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Metadata

Authors
Verma, A., Champagne, J., Sapp, J., Essebag, V., Novak, P., Skanes, A., Morillo, C. A., Khaykin, Y., & Birnie, D.
Affiliations
Southlake Regional Health Center (CA)
Corresponding author
Verma, Atul
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2013-01-28
Volume
173
Issue
2
Pages
149
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2013.1561
OpenAlex
W2054893624
Cited by
315
References
30
Citations by year
2026: 18 · 2025: 14 · 2024: 25 · 2023: 14 · 2022: 18 · 2021: 26 · 2020: 15 · 2019: 26 · 2018: 20 · 2017: 30 · 2016: 28 · 2015: 23 · 2014: 40 · 2013: 15
FWCI
16.67
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
atrial fibrillation, catheter ablation, radiofrequency ablation, asymptomatic atrial fibrillation, implantable cardiac monitors, arrhythmia burden, atrial flutter, atrial tachycardia, heart rate variability, automated arrhythmia detection, predictors of recurrence, atrial fibrillation recurrence
MeSH terms
Aged, Atrial Fibrillation, Atrial Flutter, Canada, Female, Humans, Male, Middle Aged, Prospective Studies, Tachycardia, Supraventricular, Electrocardiography, Ambulatory, Incidence, Treatment Outcome, Catheter Ablation, Asymptomatic Diseases

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