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

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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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“Although Afib is often asymptomatic [100, 101, 103, 104], advancing age is one of the strongest independent predictors of Afib.”
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Atrial Arrhythmia Burden as an Endpoint in Clinical Trials: Is it the Best Surrogate? Lessons from a Multicenter Defibrillator Trial
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Diagnosing Paroxysmal Atrial Fibrillation: Are Biomarkers the Solution to This Elusive Arrhythmia?
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“Detektion von paroxysmalem Vorhofflimmern Bei Patienten mit kryptogenem Schlaganfall besteht die Indikation für eine Langzeit-EKG-Registrierung zur Suche nach bisher unerkanntem Vorhofflimmern: Etwa die Hälfte der Vorhofflimmerepisoden bei Patienten mit paroxysmalem Vorhofflimmern verläuft asymptomatisch [53, 54, 55].”
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Efficacy of Amiodarone for Preventing the Recurrence of Symptomatic Paroxysmal and Persistent Atrial Fibrillation After Cardioversion
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Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin
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“However, a baseline resting ECG may be insufficient for diagnosing AF, as it can be paroxysmal and asymptomatic (18, 19).”
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Left Atrial Function Assessed by Doppler Echocardiography Rather Than Left Atrial Volume Predicts Recurrence in Patients With Paroxysmal Atrial Fibrillation
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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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