Recurrence rate of atrial fibrillation after the first clinical episode: A prospective evaluation using continuous cardiac rhythm monitoring

Abstract

Background: Decision making regarding a patient who has experienced a first clinical episode of atrial fibrillation (AF) is challenging, and the AF recurrences should be a significant consideration. Continuous long-term rhythm monitoring via implantable loop recorders (ILRs) has enabled us to evaluate the AF recurrence profile after the first clinical episode and to investigate clinical parameters associated with the course of the arrhythmia.

Hypothesis: Continuous rhythm monitoring via ILRs in AF patients after the first clinical episode is of clinical significance and precisely evaluate the AF recurrence profile.

Methods: Thirty consecutive patients with paroxysmal AF received an ILR after their first symptomatic episode. We evaluated the maximum duration of episodes and the recurrence rate of the arrhythmia during a follow-up period of 3 years.

Results: Three patients (10%) had no AF recurrence, whereas 4 patients (13.3%) presented only 1 episode. Almost half of the patients (46.7%) had a low recurrence rate (<5 episodes/year), whereas the majority of patients (19/30) suffered from episodes with maximum duration ≤24 hours. Eleven patients (36.7%) presented either no episode or a low recurrence rate with episodes lasting ≤24 hours. The use of statins was greater in patients with a low recurrence rate (P = 0.025).

Conclusions: A significant percentage of patients either suffer no AF recurrence after their first symptomatic episode or show a low recurrence rate. Most patients present episodes of short duration. If these findings are confirmed in larger studies, they could have clinical implications ensuring individualized management of the arrhythmia in the future.

Keywords: Anticoagulation; Arrhythmia; Atrial Fibrillation; Continuous Monitoring; Implantable Loop Recorder.

Conflict of interest statement

Emmanuel N. Simantirakis received a research grant from Medtronic Inc. (A 1065096 and SQ‐1679).

© 2018 Wiley Periodicals, Inc.

Figures

Figure 1

Categorization of AF patients according to the recurrence rate and maximum duration of the arrhythmia. The patients were divided according to the number of AF episodes per year (

Figure 2

Representative data from the ILRs of 2 patients. (a) Data from a 63‐year‐old male patient with a low recurrence rate of AF. The histograms show an episode of paroxysmal AF that lasted 14 hour 54 minutes, with a median ventricular rate of 87 bpm and a maximum ventricular rate of 158 bpm. (b) Data from a 58‐year‐old patient with a high recurrence rate of AF. The histograms show several episodes of paroxysmal AF that were cardioverted spontaneously. Abbreviations: AF, atrial fibrillation; AT, atrial tachyarrhythmia; ILRs, implantable loop recorders; V, ventricular