Relationship between silent atrial fibrillation and the maximum heart rate in the 24-hour Holter

cross-sectional study

Authors

  • Marcelo Lapa Kruse Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • José Cláudio Lupi Kruse Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Tiago Luiz Luz Leiria Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Leonardo Martins Pires Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Caroline Saltz Gensas Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Daniel Garcia Gomes Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Douglas Boris Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Augusto Mantovani Instituto de Cardiologia – Fundação Universitária de Cardiologia
  • Gustavo Glotz de Lima Instituto de Cardiologia – Fundação Universitária de Cardiologia

Keywords:

Atrial fibrillation, Signs and symptoms, Electrocardiography, ambulatory, Arrhythmias, cardiac, Electrophysiology

Abstract

CONTEXT AND OBJECTIVE: Occurrences of asymptomatic atrial fibrillation (AF) are common. It is important to identify AF because it increases morbidity and mortality. 24-hour Holter has been used to detect paroxysmal AF (PAF). The objective of this study was to investigate the relationship between occurrence of PAF in 24-hour Holter and the symptoms of the population studied. DESIGN AND SETTING: Cross-sectional study conducted at a cardiology hospital. METHODS: 11,321 consecutive 24-hour Holter tests performed at a referral service were analyzed. Patients with pacemakers or with AF throughout the recording were excluded. RESULTS: There were 75 tests (0.67%) with PAF. The mean age was 67 ± 13 years and 45% were female. The heart rate (HR) over the 24 hours was a minimum of 45 ± 8 bpm, mean of 74 ± 17 bpm and maximum of 151 ± 32 bpm. Among the tests showing PAF, only 26% had symptoms. The only factor tested that showed a correlation with symptomatic AF was maximum HR (165 ± 34 versus 147 ± 30 bpm) (P = 0.03). Use of beta blockers had a protective effect against occurrence of PAF symptoms (odds ratio: 0.24, P = 0.031). CONCLUSIONS: PAF is a rare event in 24-hour Holter. The maximum HR during the 24 hours was the only factor correlated with symptomatic AF, and use of beta blockers had a protective effect against AF symptom occurrence.

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Author Biographies

Marcelo Lapa Kruse, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD, MSc. Medical Electrophysiologist, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

José Cláudio Lupi Kruse, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD.Cardiologist, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Tiago Luiz Luz Leiria, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD, MSc, PhD. Medical Electrophysiologist, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Leonardo Martins Pires, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD, MSc. Medical Electrophysiologist, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Caroline Saltz Gensas, Instituto de Cardiologia – Fundação Universitária de Cardiologia

Medical Student, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Scientific Initiation Student, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Daniel Garcia Gomes, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD. Resident, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Douglas Boris, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD. Resident, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Augusto Mantovani, Instituto de Cardiologia – Fundação Universitária de Cardiologia

Medical Student, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), and Scientific Initiation Student, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Gustavo Glotz de Lima, Instituto de Cardiologia – Fundação Universitária de Cardiologia

MD, PhD. Medical Electrophysiologist, Electrophysiology Service, Instituto de Cardiologia – Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil.

References

Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946-52.

Cabin HS, Clubb KS, Hall C, Perlmutter RA, Feinstein AR. Risk for systemic embolization of atrial fibrillation without mitral stenosis. Am J Cardiol. 1990;65(16):1112-6.

Petersen P, Godtfredsen J. Embolic complications in paroxysmal atrial fibrillation. Stroke. 1986;17(4):622-6.

Page RL, Tilsch TW, Connolly SJ, et al. Asymptomatic or ‘’silent’’ atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation. 2003;107(8):1141-5.

Miller CS, Grandi SM, Shimony A, Filion KB, Eisenberg MJ. Meta- analysis of efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus warfarin in patients with atrial fibrillation. Am J Cardiol. 2012;110(3):453-60.

Halimi F, Van Erven L, EHRA Scientific Initiatives Committee. Validation of success following atrial fibrillation ablation: a European survey. Europace. 2009;11(8):1002-3.

Fenelon G, Scanavacca M, Atié J, et al. Atrial fibrillation ablation in Brazil: results of the registry of the Brazilian Society of Cardiac Arrhythmias. Arq Bras Cardiol. 2007;89(5):258-62.

Zimerman LI, Fenelon G, Martinelli Filho M, et al. Diretrizes Brasileiras de Fibrilação Atrial. Arq Bras Cardiol. 2009;92(6 supl. 1):1-39. Available from: http://publicacoes.cardiol.br/consenso/2009/diretriz_fa_92supl01.pdf. Accessed in 2013 (Oct 28).

Humphries KH, Kerr CR, Steinbuch M, Dorian P; Canadian Registry of Atrial Fibrillation investigators. Limitations to antiarrhythmic drug use in patients with atrial fibrillation. CMAJ. 2004;171(7):741-5.

Hindricks G, Piorkowski C, Tanner H, et al. Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation. 2005;112(3):307-13.

Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R. Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke. 2004;35(7):1647-51.

Verma A, Champagne J, Sapp J, et al. Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study. JAMA Intern Med. 2013;173(2):149-56.

Mehall JR, Kohut RM Jr, Schneeberger EW, Merrill WH, Wolf RK. Absence of correlation between symptoms and rhythm in “symptomatic” atrial fibrillation. Ann Thorac Surg. 2007;83(6):2118-21.

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Published

2014-12-12

How to Cite

1.
Kruse ML, Kruse JCL, Leiria TLL, Pires LM, Gensas CS, Gomes DG, Boris D, Mantovani A, Lima GG de. Relationship between silent atrial fibrillation and the maximum heart rate in the 24-hour Holter: cross-sectional study. Sao Paulo Med J [Internet]. 2014 Dec. 12 [cited 2025 Mar. 14];132(6):355-9. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1245

Issue

Vol. 132 No. 6 (2014)

Section

Original Article

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