Background Atrial fibrillation (AF) is an epidemic disease. Outcomes and treatment are determined by symptoms and risk posed. These may be influenced by absolute AF burden, degree of temporal dispersion of episodes, and/or progression to persistent arrhythmia. Characterisation is challenging with traditional intermittent ECG monitoring because the arrhythmia is evanescent and largely asymptomatic. Implanted devices with remote monitoring (RM) mechanisms may enable automatic continuous monitoring with accurate arrhythmia resolution. This was tested.
Methods and Results 276 consecutive patients with RM pacemakers were followed for 12±2 months, 29 experienced at least 1 day with AF. In each patient, AF days were classed by mode switch duration (irrespective of mode switch number) according to >6, >12, >18 and >24 h/day. AF burden differed among and within individuals for example, one patient had only one AF day contrasting with 93 in another. In patient 15, 81/93 days were associated with >18 h of AF that is, AF burden was heavy when it occurred, but patient 20 had 7 AF days but none exceeded 18 h duration per day. Similar variabilities were observed in heart failure patients (TRUST trial). Though conventionally considered at high risk for AF, <10% patients developed AF of >2 h/day in 1 year.
Conclusion Wide diversity in AF arrhythmia load likely impart different risks and require different treatment. Understanding may be enhanced by continuous remote monitoring and permit reevaluation of current clinical management guidelines.
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