Problems in pharmacological evaluation of patients with paroxysmal atrial fibrillation:Clinical analysis of more than 100 consecutive patients
Kanji Iga, Chisato Izumi, Atsushi Nakano, Yuji Sakanoue, Tadashi Miyamoto, Shouji Kitaguchi, Yoshihiro Himura, Hiromitsu Gen, Takashi Konishi
Abstract
To address the problems of pharmacological evaluation in paroxysmal atrial
fibrillation (PAf), we interviewed 108 consecutive patients with documented
PAf regarding symptoms, frequency and trigger factors of PAf and analyzed
the 24-hour ambulatory electrocardiographic monitoring (Holter monitoring)
records in relation to symptoms. Twenty-nine patients were totally asymptomatic,
while 79 patients were symptomatic of which 49 patients had obvious trigger
factors. PAf was documented by Holter monitoring in 22 of 79 symptomatic
patients. On analysis of PAf-documented 25 Holter monitoring records, the
patients checked event marks as PAf in only 20 of 155 PAf episodes. Six
episodes of 26 event marks that patients thought to be PAf proved to be
premature atrial or ventricular contractions. Nine patients in whom PAf
persisted for more than 24 hours became asymptomatic. Patients suitable
for pharmacological evaluation constituted about one-fifth of the PAf patients
in our consecutive study. Even with the selection of these patients, pharmacological
evaluation based on symptoms is difficult because disappearance of PAf
may be associated with persistent atrial fibrillation.