Goulouti, Eleni; Lam, Anna; Nozica, Nikolas; Elchinova, Elena; Dernektsi, Chrisoula; Neugebauer, Felix; Branca, Mattia; Servatius, Helge; Noti, Fabian; Häberlin, Andreas; Thalmann, Gregor; Kozhuharov, Nikola Asenov; Madaffari, Antonio; Tanner, Hildegard; Reichlin, Tobias; Roten, Laurent (2024). Incidental Arrhythmias During Atrial Fibrillation Screening With Repeat 7-Day Holter ECGs in a Hospital-Based Patient Population. Journal of the American Heart Association, 13(4), e032223. American Heart Association 10.1161/JAHA.123.032223
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goulouti-et-al-2024-incidental-arrhythmias-during-atrial-fibrillation-screening-with-repeat-7-day-holter-ecgs-in-a.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (994kB) | Preview |
BACKGROUND
Screening for atrial fibrillation (AF) may reveal incidental arrhythmias of relevance. The aim of this study was to describe incidental arrhythmias detected during screening for AF in the STAR-FIB (Predicting SilenT AtRial FIBrillation in Patients at High Thrombembolic Risk) cohort study.
METHODS AND RESULTS
In the STAR-FIB cohort study, we screened hospitalized patients for AF with 3 repeat 7-day Holter ECGs. We analyzed all Holter ECGs for the presence of the following incidental arrhythmias: (1) sinus node dysfunction, defined as sinus pause of ≥3 seconds' duration; (2) second-degree (including Wenckebach) or higher-degree atrioventricular block (AVB); (3) sustained supraventricular tachycardia of ≥30 seconds' duration; and (4) sustained ventricular tachycardia of ≥30 seconds' duration. We furthermore report treatment decisions because of incidental arrhythmias. A total of 2077 Holter ECGs were performed in 794 patients (mean age, 74.7 years; 49% women), resulting in a mean cumulative duration of analyzable ECG signal of 414±136 hours/patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were sinus node dysfunction in 14 patients (1.8%), AVB in 41 (5.2%), supraventricular tachycardia in 42 (5.3%), and ventricular tachycardia in 2 (0.3%). Second-degree AVB was found in 23 patients (2.9%), 2:1 AVB in 10 (1.3%), and complete AVB in 8 (1%). Subsequently, 8 patients underwent pacemaker implantation, 1 for sinus node dysfunction (post-AF conversion pause of 9 seconds) and 7 for advanced AVB. One patient had an implantable cardioverter-defibrillator implanted for syncopal ventricular tachycardia.
CONCLUSIONS
Incidental arrhythmias were frequently detected during screening for AF in the STAR-FIB study and resulted in device therapy in 1.1% of our cohort patients.
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