Abstract 14452: Do Patient-Reported Symptoms on Ambulatory Electrocardiogram Correlate With Atrial Arrhythmia Episodes?

Abstract

Introduction: Guidelines regarding rhythm control for atrial arrhythmias (AT/AF) are primarily based on symptom burden. Ambulatory electrocardiogram (AECG) monitoring is often performed to evaluate AT/AF burden and guide clinical decision-making. Yet, to date, little is known about the correlation of symptoms reported during AECG with recorded AT/AF. Methods: University of Utah patient AECGs with at least one AT/AF event over 7 or more days of monitoring were retrospectively reviewed - only events with symptoms or with AT/AF were included (other arrhythmias were rare and excluded). Patient triggered symptoms included reported shortness of breath, tiredness, palpitations, dizziness, or passing out. Tetrachoric correlation analysis was performed to evaluate the correlation between symptoms and AT/AF episodes. Results: We identified 742 patients with a mean age of 64 years, 50% female, 22% with chronic heart failure, overall mean CHA 2 DS 2 -VASc score of 2.5 and 67% with scores ≥2. There were 6,289 symptomatic events and 6,900 AT/AF episodes. Among these were 1,025 (16%) episodes of shortness of breath, 854 (14%) of tiredness, 2,660 (42%) of palpitations, 794 (13%) of dizziness, and 95 (2%) of passing out. Symptomatic events were less likely to predict simultaneous AT/AF compared to sinus rhythm on AECG, with a moderate inverse tetrachoric correlation of -0.66 (range -1 to 1, with 1 representing perfect positive correlation). Conclusion: Patient-triggered symptomatic events were inversely correlated with recorded AT/AF events and represented an unacceptable marker of actual arrhythmia. A more holistic approach to assessment of ATAF symptoms is needed to improve patient selection for rhythm control therapy.