Atrial fibrillation in ventricular-paced rhythm: under-recognised, underdiagnosed and potentially dangerous

There is only scant published evidence demonstrating the importance of diagnosing atrial fibrillation (AF) in patients with a ventricularly paced rhythm. This potential pitfall to recognise AF has the implication of devastating outcomes.

A short survey was undertaken in order to gauge the ability of doctors of all grades to recognise AF, and adequate anticoagulation, in the patient with chronic right ventricular pacing (RVp), based on ECG interpretation. Participants were trainee doctors from different grades including foundation doctors, core medical trainee, specialist registrars and consultants.

Only 11.3% of doctors correctly identified the need for oral anticoagulation. There was no association between four groups (F1, F2, core medical training (CMT) and SpR) and incorrect answers (Fisher's exact test, value=4.082, p=0.252). However, there was a trend of better AF recognition towards registrar but this has not reached statistical significance.

Our study demonstrates severe systemic under-recognition of this fairly common condition among hospital doctors. This may lead to a lower rate of anticoagulation and a higher incidence of thromboembolic events.