Paroxysmal atrial fibrillation: ectopic atrial activity and prevalence of severely symptomatic patients

Catheter ablation is a promising approach in severely symptomatic patients with paroxysmal atrial fibrillation (PAF). Until this time it has only been performed in highly selected patients with weekly episodes and frequent premature atrial contractions (PACs). The aim of the present study was to estimate the prevalence of severely symptomatic patients with PAF and to evaluate the significance of PACs. The files of 7,447 consecutive patients were screened and 1,357 PAF patients identified. Holter recordings were performed in 108 patients with >/=2 spontaneous AF episodes. Despite antiarrhythmic treatment, 6.5% (1.8-11.1%) had a history of weekly PAF episodes. 29.2% of patients and 10% of healthy, age-matched controls had more than 700 PACs. The number of PACs was inversely related to the reported numbers of previous episodes and directly related to age and size of left atrium. We estimate that about 6.5% of patients with PAF are severely symptomatic and might benefit from catheter ablation. Our data suggest that the number of PACs should not be used as a selection criterion for catheter ablation. Frequent PACs are seen in a substantial proportion of elderly healthy individuals.