Clinical InvestigationElectrophysiologyClinical characteristics of patients with asymptomatic recurrences of atrial fibrillation in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial
Section snippets
Methods
The rationale, design, and results of GISSI-AF trial have already been published16, 17 (Clinical Trials.gov Identifier: NCT00376272). This trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial, to assess whether addition of the angiotensin II–receptor blocker valsartan to established therapies could reduce the recurrence of AF in patients with a history of AF associated with cardiovascular diseases.
Patients eligible for inclusion in the study were of both
Clinical characteristics of AF recurrences
Of the 2,149 AF recurrences in GISSI-AF trial,16 we analyzed 1,638 AF episodes that were properly classified as symptomatic (n = 979; 59.8%) or asymptomatic (n = 659; 40.2%). Among this latter group, the diagnosis of asymptomatic recurrence was based on the detection of AF in the weekly programmed electrocardiographic transtelephonic transmission in 466 (70.7%) of 659 episodes.
Mean ventricular response was correlated with symptoms: heart rate was significantly lower in asymptomatic AF
Discussion
Our study, which enrolled a large number of ambulatory patients with paroxysmal and persistent AF and represents common clinical practice, indicates that asymptomatic recurrences are a relevant phenomenon, which involves up to 50% of the study population when arrhythmias detection is based on both transtelephonic electrocardiographic transmissions and programmed controls. The occurrence of this type of events was associated with important clinical implications that could affect patients'
Conclusions
Our results indicate that in ambulatory patients, AF recurrences in the absence of symptoms are a common event. In these patients, a longer duration of both the qualifying arrhythmic event and the arrhythmic recurrence predicts the presence of AF as the dominant rhythm at the end of the 1-year follow-up. We also observed that patients with asymptomatic recurrences had more frequently a CHADS2 score ≥2 than did the symptomatic ones. This finding further supports the recommendation that the
Disclosures
Conflict of interest: There are no conflicts of interest for this post hoc analysis.
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2017, International Journal of CardiologyCitation Excerpt :These medication decrease HR, causing better tolerance of arrhythmia, which may explain our findings. Similarly, in the GISSI-AF study, patients who more frequently use Ca2 + blockers characterized patients with SAF [12]. Also, in our study, the patients with diuretic therapy had SAF almost 5 times more frequent.
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Randomized Clinical Trial registration no. NCT00376272.
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GSSI-AF Investigators. A complete list of GISSI-AF study committees, collaborators, and participating centers is published in N Engl J Med 2009;360:1606-17.