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Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia
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, 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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Metadata
- Authors
- Page, R. L., Wilkinson, W. E., Clair, W. K., McCarthy, E. A., & Pritchett, E. L.
- Affiliations
- Duke Medical Center (US)
- Venue
- Circulation
- Published
- 1994-01
- Volume
- 89
- Issue
- 1
- Pages
- 224-227
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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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