Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia

Page, R L; Wilkinson, W E; Clair, W K; McCarthy, E A; Pritchett, E L

doi:10.1161/01.cir.89.1.224

Cited by 627Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmias

Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia

Page, R L, Wilkinson, W E, Clair, W K, McCarthy, E A, Pritchett, E L·1994·Circulation

DOI 10.1161/01.cir.89.1.224

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Abstract

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.

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Paroxysmal AF is often asymptomatic whilst paroxysmal SVT is usually symptomatic.
“Paroxysmal AF is often asymptomatic whilst paroxysmal SVT is usually symptomatic, 13”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [13]

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Kirchhof, P., Bax, J., Blomstrom-Lundquist, C., Calkins, H., Camm, A. J., Cappato, R., Cosio, F., Crijns, H., Diener, H.-C., Goette, A., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp235 · Cited by 202 · see citing works
Self-citation
A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland
Murphy, N., Simpson, C., Jhund, P., Stewart, S., Kirkpatrick, M., Chalmers, J., Macintyre, K., & McMurray, J. (2007) · Heart · doi:10.1136/hrt.2006.107573 · Cited by 209 · see citing works
Relationship between atrial tachyarrhythmias and symptoms
Strickberger, S. A., Ip, J. E., Saksena, S. V., Curry, K., Bahnson, T. D., & Ziegler, P. (2005) · Heart Rhythm · doi:10.1016/j.hrthm.2004.10.042 · Cited by 198 · see citing works
Medical Services Advisory Committee
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Clinical Classifications of Atrial Fibrillation Poorly Reflect Its Temporal Persistence
Charitos, E. I., Pürerfellner, H., Glotzer, T. V., & Ziegler, P. D. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.04.019 · Cited by 188 · see citing works
“It is well established that these brief monitoring snapshots do not accurately capture the true arrhythmia status (5,6,29) and that relying on patient symptoms can lead to both under-reporting and over-reporting of AF (3,4,30).”
Background
European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE)
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Validation of a New Simple Scale to Measure Symptoms in Atrial Fibrillation
Dorian, P., Guerra, P. G., Kerr, C. R., O’Donnell, S., Crystal, E., Gillis, A. M., Mitchell, L. B., Roy, D., Skanes, A. C., Rose, M. S., et al. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.108.812347 · Cited by 180 · see citing works
Combined Efficacy of Atrial Septal Lead Placement and Atrial Pacing Algorithms for Prevention of Paroxysmal Atrial Tachyarrhythmia
Padeletti, L., Pürerfellner, H., Adler, S. W., Waller, T., Harvey, M. N., HORVITZ, L., Holbrook, R., Kempen, K. P., Mugglin, A. S., Hettrick, D. A., et al. (2003) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2003.03191.x · Cited by 177 · see citing works
Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials
Naccarelli, G. V., Wolbrette, D. L., Khan, M. R., Bhatta, L., Hynes, J. K., Samii, S. M., & Luck, J. C. (2003) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)03375-1 · Cited by 172 · see citing works
Atrial fibrillation following cardiac surgery: clinical features and preventative strategies
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“Routine transtelephonic ECG records revealed 17% of asymptomatic AF recurrences Page et al.(11) Repeated 24 h Holter ECG monitorings: asymptomatic AF episodes 12 times more frequent compared with symptomatic AF Schuchert et al.”
Background
Incidence of Newly Detected Atrial Arrhythmias via Implantable Devices in Patients With a History of Thromboembolic Events
Ziegler, P. D., Glotzer, T. V., Daoud, E. G., Wyse, D. G., Singer, D. E., Ezekowitz, M. D., Koehler, J. L., & Hilker, C. E. (2010) · Stroke · doi:10.1161/strokeaha.109.571455 · Cited by 173 · see citing works
“颤动既不敏感也非特异 ([1,2]),通过外部设备进行心律监测存在间断取样 [3] 和患者依从性不佳 [4] 的问题。”
Long‐Term Outcome of Radiofrequency Catheter Ablation for Topical Atrial Flutter: Risk Prediction of Recurrent Arrhythmias
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Asymptomatic or “Silent” Atrial Fibrillation
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Self-citation
Symptomatic and Asymptomatic Atrial Fibrillation in Patients Undergoing Radiofrequency Catheter Ablation
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Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter
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Clinical and echocardiographic features of intermittent atrial fibrillation that predict recurrent atrial fibrillation
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Healthy Sleep Patterns and Risk of Incident Arrhythmias
Li, X., Zhou, T., Ma, H., Huang, T., Gao, X., Manson, J. E., & Qi, L. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.07.023 · Cited by 154 · see citing works
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“This can be misleading, as in one study asymptomatic PAF occurred 12 times more commonly than symptomatic PAF in patients when followed up longitudinally by Holter monitoring.(2) PAF is usually defined temporally, as intermittent periods of AF interspersed with episodes of normal sinus rhythm, normally lasting -7 days…”
Background
Atrial fibrillation: strategies to control, combat, and cure
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Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation
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Prospective comparison of flecainide versus quinidine for the treatment of paroxysmal atrial fibrillation/flutter
Naccarelli, G. V., Dorian, P., Hohnloser, S. H., & Coumel, P. (1996) · The American Journal of Cardiology · doi:10.1016/s0002-9149(97)89118-7 · Cited by 134 · see citing works
ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT)
Hohnloser, S. H., Capucci, A., Fain, E. S., Gold, M. R., Gelder, I. C. V., Healey, J. S., Israel, C. W., Lau, C., Morillo, C. A., & Connolly, S. J. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.02.016 · Cited by 129 · see citing works
Comparison of autotriggered memory loop recorders versus standard loop recorders versus 24-hour Holter monitors for arrhythmia detection
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Newly Diagnosed Atrial Fibrillation
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Self-citation
Asymptomatic Atrial Fibrillation
Rho, R. W., & Page, R. L. (2005) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2005.06.005 · Cited by 125 · see citing works
Self-citation
Quality of life in patients with atrial fibrillation: how to assess it and how to improve it
Aliot, E., Botto, G. L., Crijns, H. J. G. M., & Kirchhof, P. F. (2014) · EP Europace · doi:10.1093/europace/eut369 · Cited by 123 · see citing works
“Asymptomatic AF may be more common than symptomatic AF in patients with PAF.(85) Early treatment in addition to identification of patients at risk may help improve the impact of treatments on QoL.”
Background
Prevalence of Asymptomatic Recurrences of Atrial Fibrillation After Successful Radiofrequency Catheter Ablation
Oral, H., Veerareddy, S., Good, E. D., HALL, B. W., Cheung, P. W., Tamirisa, K. P., Han, J. D., Fortino, J., Chugh, A., Bogun, F. M., et al. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.04055.x · Cited by 119 · see citing works
Radiofrequency Catheter Ablation of Common Atrial Flutter
Anselme, F., Saoudi, N. C., Poty, H., Douillet, R., & Cribier, A. G. (1999) · Circulation · doi:10.1161/01.cir.99.4.534 · Cited by 121 · see citing works
Effect of C-reactive protein reduction on paroxysmal atrial fibrillation
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Asymptomatic Atrial Fibrillation in Pacemaker Recipients: Incidence, Progression, and Determinants Based on the Atrial High Rate Trial
Orlov, M. V., Ghali, J. K., Araghi‐Niknam, M., Sherfesee, L., Sahr, D. M., Hettrick, D. A., & for the Atrial High Rate Trial Investigators (2007) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2007.00682.x · Cited by 119 · see citing works
Atrial fibrillation: Maintenance of sinus rhythm versus rate control
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Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients
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Kirchhof, P. F., Bax, J. J., Blomstrom-Lundquist, C., Calkins, H., Camm, A. J., Cappato, R., Cosío, F. G., Crijns, H. J. G. M., Diener, H., Goette, A., et al. (2009) · EP Europace · doi:10.1093/europace/eup124 · Cited by 110 · see citing works
“The clinical relevance of AF of 30 s duration (as opposed, for example, to 60 s or 5 min) has never been systematically studied and was chosen arbitrarily based on available recording technology and in concert with the definition of sustained ventricular tachyarrhythmias.(82) Modern, long-term, ECG monitoring tools, s…”
MethodSelf-citation
First experience with a Mobile Cardiac Outpatient Telemetry (MCOT) system for the diagnosis and management of cardiac arrhythmia
Joshi, A. K., Kowey, P. R., Prystowsky, E. N., Benditt, D. G., Cannom, D. S., Pratt, C. M., McNamara, A., & Sangrigoli, R. M. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.12.015 · Cited by 110 · see citing works
Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK
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“This could be misleading, as asymptomatic paroxysmal AF is quite common [5,6].”
Background
Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort
Ip, J. E., Waldo, A. L., Lip, G. Y. H., Rothwell, P. M., Martin, D. T., BERSOHN, M. M., Choucair, W. K., Akar, J. G., Wathen, M. S., Rohani, P., et al. (2009) · American Heart Journal · doi:10.1016/j.ahj.2009.07.002 · Cited by 106 · see citing works

Authors: Page, R. L., Wilkinson, W. E., Clair, W. K., McCarthy, E. A., & Pritchett, E. L.
Affiliations: Duke Medical Center (US)
ORCID: Page, R L
Wilkinson, W E
Clair, W K
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1994-01
Volume: 89
Issue: 1
Pages: 224-227
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.89.1.224
OpenAlex: W2010550566
Cited by: 627
References: 0
Citations by year: 2026: 3 · 2025: 5 · 2024: 12 · 2023: 15 · 2022: 16 · 2021: 19 · 2020: 11 · 2019: 9 · 2018: 20 · 2017: 19 · 2016: 21 · 2015: 25 · 2014: 29 · 2013: 25 · 2012: 31
FWCI: 7.88
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (1r01hl040392-01a1)
National Heart, Lung, and Blood Institute (R01-HL-40392)
National Center for Research Resources (MO 1 RR-30)
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 electrophysiology and arrhythmias
Keywords: paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, asymptomatic arrhythmia, arrhythmia frequency, Holter monitoring, stroke risk, antiarrhythmic drugs, calcium channel blockers, beta-blockers
MeSH terms: Atrial Fibrillation, Female, Humans, Male, Middle Aged, Stochastic Processes, Tachycardia, Paroxysmal, Tachycardia, Supraventricular, Time Factors, Electrocardiography, Ambulatory, Confidence Intervals

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Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia

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