Other rhythm abnormalities found in 10, 593 patients with paroxysmal atrial fibrillation over a 14-day ambulatory ECG monitoring period. (3rd October 2022) - Bardy, G
Abstract: Background: The incidence of other arrhythmias in patients with Paroxysmal Atrial Fibrillation (PAF) can affect choice of subsequent diagnostic procedures as well as drug, implanted device and ablation management. In the endless stream of new ECG monitoring technologies, whose primary focus sits on AF identification, other arrhythmias can be minimized in their importance. And yet, in patients with PAF, management is often altered by the presence of both significant and even subtle additional concomitant rhythm abnormalities. Clinically meaningful non-PAF rhythms may not be reliably captured by most cardiac ambulatory ECG monitors, especially those focusing purely on AF. Purpose: The objective of this study was to identify the extent and types of other unique rhythm abnormalities that might influence management in patients found to have PAF on a routine outpatient ambulatory ECG. Methods: A total of 10, 593 pts wearing an ambulatory ECG monitor had PAF. Monitors were ordered for standard clinical indications predominantly by their managing cardiologists. Patient ECG data was interpreted by 3 serial readers clinically informed on electrophysiological principles of arrhythmia diagnostics. Concomitant rhythm disorders, as manifested on the surface ECG monitor, were then quantified as a percentage of the PAF study population. Patients with chronic AF were excluded from this analysis. Results: The primary results are summarized in Figure 1. Of 10, 593 pts with PAF, only 391 (4%) were found to have only PAF and no other rhythm abnormalities. At least 1 additional rhythm abnormality was found in 96% and 2-to-8 additional rhythm disorders were present in 68% of patients. Conclusion: Nearly all patients with PAF have additional rhythm abnormalities that can only be identified using a cardiac monitor with high P-wave fidelity. Even modest, and certainly serious, additional ECG rhythm abnormalities can alter physician management of PAF as pertains to selection of additional diagnostic testing, drug choice, device selection, and/or ablation specifics. Simplistic and/or commercial grade ECG monitors cannot provide such detail and carry the risk of misdirecting patient management. Funding Acknowledgement: Type of funding sources: None.