atrial fibrillation

Recently I had 3 brief ( less than 60 seconds) of rapid atrial rate interpreted by the PM  ( or the tech) as atrial fibrillation. Paroxysmal AF (PAF) in terms of exact defintion  ( duration, frequency etc)seem to be a bit of a unsettled issue. Though the current 2014 guidelines seem to recommend anticoagulation for any PAF regardless of degree other EP docs do not follow that plan. There is also the issue of false postives ( Something called RNRVAS  and something called far field sensing apparently can be misinterpretted as AF). Does anyone have any persoanl experience or insight to this?

 

2 Comments

I'd wait

by Tracey_E - 2016-11-14 12:04:13

Three episodes of under a minute? I would absolutely not want to treat! If it happens more often, if you have symptoms, if it's sustained, then it's time to talk about it. 

atrial fibrillation

by fox30 - 2016-11-22 16:57:51

Some recently published data on this topic appears in the October 2016 issue of the journal Circulation.Dr. Steven Swiryn and collegues analysed PM tracings from over 5000 patients and found that "short episodes" of Afib did not increase the risk of stroke. The abstract of the article defines short as one in which the onset and offset of the AF was captured within a single tracing from the atrial recording (EGM), about which another commentary said was usually 10 -20 seconds in duration.This results were actually reported ina scientific sesson of the AHA in 2012!.Takes way to long to get important information published.

This may change the thinking of some EP docs who have been recommending  anticoagulation for paroxysmal AFIB regardless of any duration, based on the risk assessment tool known as CHADS2. ( apparently there are guideline recommending that approach) These short bursts of AFib are apparently very common when the PM tracings are examined. Over 50% of patients had at least one such episode in the 2 year period of the study. 

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