Paroxysmal atrial fibrillation with silent episodes: intermittent versus continuous monitoring

Asymptomatic atrial fibrillation (AF) presents the same risk for cardioembolic events as symptomatic AF. Intermittent ECG recordings may be helpful in detecting asymptomatic paroxysmal arrhythmias. The objective of this study was to compare short intermittent heart rhythm recordings with or without symptoms with continuous ECG recordings.

Twenty-two patients with diagnosed symptomatic paroxysmal AF participated. Patients used a handheld transtelephonic ECG device for a 30-day period performing two registrations of 10 seconds per day. Additionally patients were asked to make registrations if arrhythmia symptoms occurred. Patients also performed a 24-hour ambulatory continuous ECG recording during a single twenty-four hours period of the 30 day period. AF was defined as an irregular ventricular rhythm without visible p-waves for at least 10 seconds.

1425 intermittent ECG recordings were performed. AF episodes were diagnosed in 18 (82%) patients compared with 7 (32%) patients using continuous ECG, (p = 0.001). All patients with AF detected by continuous monitoring were also detected by intermittent recordings. Of the episodes, 16% were judged as symptomatic.

Short-term ECG registrations over extended time periods seem to be a more sensitive tool, compared with short continuous ECG recordings, for detection of AF episodes.