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Treatment of underlying atrial fibrillation: paced rhythm obscures recognition.

Abstract：

OBJECTIVES:The purpose of this study was to evaluate the rate of recognition of atrial fibrillation (AF), use of warfarin and prevalence of cerebrovascular accident (CVA) in paced versus unpaced patients during admission to a tertiary care teaching hospital. BACKGROUND:The presence of AF underlying a continuously paced rhythm may be under recognized and result in a lower rate of anticoagulation and higher incidence of CVA. METHODS:The identification of AF on 12 lead electrocardiogram (ECG) and telemetry, "optimal use" of anticoagulants that is, warfarin or aspirin, when warfarin is contraindicated and history of prior CVA was studied in three groups: 1) group A with continuously paced rhythm on ECG and telemetry (n = 30), 2) group B with intermittently paced rhythm on ECG and telemetry (n = 59), and 3) group C with persistent AF and no permanent pacemaker (n = 50). RESULTS:The identification and documentation of AF was significantly lower in the continuously paced group A (20%) versus the intermittently paced group B (44%). Both groups A and B were substantially lower than unpaced controls. "Optimal use" of anticoagulants was significantly lower in group A (40%) compared with groups B (78%) and C (72%) but was not different between groups B and C. The prevalence of prior CVA was not significantly different between the three groups. CONCLUSIONS:All ECGs in patients with paced rhythm should be examined closely for underlying AF to prevent under-recognition and under-treatment with anticoagulants.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Patel AM,Westveer DC,Man KC,Stewart JR,Frumin HI

doi

10.1016/s0735-1097(00)00794-4

subject

Has Abstract

pub_date

2000-09-01 00:00:00

pages

784-7

issue

3

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(00)00794-4

journal_volume

36

pub_type

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