Patient-reported symptomatic events do not adequately reflect atrial arrhythmia

Area of Science:

• Cardiology
• Electrophysiology
• Medical Monitoring

Background:

• Atrial fibrillation (AF) management often focuses on symptom relief.
• The degree of symptom-rhythm discordance during ambulatory electrocardiography (AECG) monitoring is not well understood.

Purpose of the Study:

• To quantify the symptom-rhythm correlation (SRC) for atrial arrhythmia (atrial tachycardia/atrial fibrillation [AT/AF]) events.
• To evaluate factors influencing the association between AT/AF and patient-reported symptoms.

Main Methods:

• Retrospective cohort analysis of AECG data from a tertiary care center.
• Included AECGs of ≥7 days with at least one AT/AF episode.
• Patient-triggered symptoms (shortness of breath, tiredness, palpitations, dizziness, passing out) were analyzed alongside AT/AF events using multivariable logistic regression.

Main Results:

• 742 patients with qualifying AECG data were analyzed.
• Overall SRC was 0.39, indicating poor correlation.
• AT/AF presence increased symptom odds by ~8.3 times (adjusted analysis, P < .01).
• Prior AF rhythm control treatment and lower heart rate were associated with worse SRC (P < .01).

Conclusions:

• While AT/AF events elevate symptom probability, a poor overall correlation exists between symptomatic events and documented AT/AF.
• Patient factors and prior treatments significantly influence SRC.
• Improved understanding of SRC is crucial for optimizing AF clinical outcomes and research rigor.