Incidence of Atrial Arrhythmias Detected by Permanent Pacemakers (PPM) Post‐Pulmonary Vein Antrum Isolation (PVAI) for Atrial Fibrillation (AF): Correlation with Symptomatic Recurrence

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Abstract
Background: Studies examining AF recurrences post‐PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known. Objective: To assess the incidence of atrial tachycardia/fibrillation post‐PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence. Methods: Eighty‐six consecutive patients with symptomatic AF and PPMs with programmable mode‐switch capability underwent PVAI. Mode switching was programmed post‐PVAI to occur at an atrial‐sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post‐PVAI. The number and duration of mode‐switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range). Results: The patients (age 57 ± 8 years, EF 54 ± 10%) had paroxysmal (65%) and persistent (35%) AF pre‐PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow‐up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4–256] vs 401 [151–2,470], P < 0.01). The durations were all Conclusions: Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.

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