TY - JOUR
T1 - Demographic and clinical characteristics to predict paroxysmal atrial fibrillation
T2 - insights from an implantable loop recorder population
AU - Frontera, Antonio
AU - Carpenter, Alexander
AU - Ahmed, Nauman
AU - Fasiolo, Matteo
AU - Nelson, Martin
AU - Diab, Ihab
AU - Cripps, Tim
AU - Thomas, Glyn
AU - Duncan, Edward
PY - 2015/10
Y1 - 2015/10
N2 - Background: There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk. Methods: We retrospectively studied a population of 200 adult patients who underwent ILR implantation for the investigation of syncope or palpitations. Clinical data, baseline electrocardiogram (ECG) characteristics, and echocardiographic data were collected. All ECGs and electrograms (EGMs) were scrutinized by two blinded investigators. PAF incidence was defined as episodes lasting >30 seconds on EGMs recorded in ILR memory. Results: Our ILR population consists of 200 patients, 111 (56%) male, with a mean age of 61.4 years (range 19-95). PAF was detected in 42 patients. The following factors were significant predictors of PAF by multivariate logistic regression analysis: cigarette smoking (odds ratio [OR] = 3.73, 95% confidence interval [CI] = 1.40-10.24, P = 0.009) and incomplete right bundle branch block (IRBBB; OR = 9.04, 95% CI = 2.51-34.64, P = 0.00088). Significant differences included incidence of IRBBB (P = 0.012), cigarette smoking (P = 0.026), hypercholesterolemia (P = 0.015), age (P = 0.002), estimated glomerular filtration rate (P = 0.031), left atrial volume (P = 0.019), and PR interval (P = 0.031). The PAF group had significantly higher CHA2DS2-VASc scores (P = 0.01). Conclusions: Our study reports predictive factors for PAF in an ILR population. We suggest that cigarette smoking and IRBBB are independently associated with paroxysmal AF in patients presenting with palpitations or syncope.
AB - Background: There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk. Methods: We retrospectively studied a population of 200 adult patients who underwent ILR implantation for the investigation of syncope or palpitations. Clinical data, baseline electrocardiogram (ECG) characteristics, and echocardiographic data were collected. All ECGs and electrograms (EGMs) were scrutinized by two blinded investigators. PAF incidence was defined as episodes lasting >30 seconds on EGMs recorded in ILR memory. Results: Our ILR population consists of 200 patients, 111 (56%) male, with a mean age of 61.4 years (range 19-95). PAF was detected in 42 patients. The following factors were significant predictors of PAF by multivariate logistic regression analysis: cigarette smoking (odds ratio [OR] = 3.73, 95% confidence interval [CI] = 1.40-10.24, P = 0.009) and incomplete right bundle branch block (IRBBB; OR = 9.04, 95% CI = 2.51-34.64, P = 0.00088). Significant differences included incidence of IRBBB (P = 0.012), cigarette smoking (P = 0.026), hypercholesterolemia (P = 0.015), age (P = 0.002), estimated glomerular filtration rate (P = 0.031), left atrial volume (P = 0.019), and PR interval (P = 0.031). The PAF group had significantly higher CHA2DS2-VASc scores (P = 0.01). Conclusions: Our study reports predictive factors for PAF in an ILR population. We suggest that cigarette smoking and IRBBB are independently associated with paroxysmal AF in patients presenting with palpitations or syncope.
KW - Cryptogenic stroke
KW - Implantable loop recorder
KW - Paroxysmal atrial fibrillation
KW - Right bundle branch block
UR - http://www.scopus.com/inward/record.url?scp=84940054989&partnerID=8YFLogxK
UR - http://dx.doi.org/10.1111/pace.12692
U2 - 10.1111/pace.12692
DO - 10.1111/pace.12692
M3 - Article
SN - 0147-8389
VL - 38
SP - 1217
EP - 1222
JO - Pacing and Clinical Electrophysiology
JF - Pacing and Clinical Electrophysiology
IS - 10
ER -