Patient-reported Symptomatic Events Do Not Adequately Reflect Atrial Arrhythmia

Abstract

BackgroundManagement of atrial fibrillation is frequently geared towards improving symptoms. Yet, the magnitude of symptom rhythm discordance is not well known in the setting of ambulatory electrocardiographic (AECG) monitoring. ObjectiveWe aimed to quantify the symptom rhythm correlation for atrial arrhythmia (AT/AF) events. MethodsThis was a retrospective cohort analysis of AECG data at a tertiary care center. All AECGs of >7 days with at least one AT/AF were included. Patient-triggered symptoms included shortness of breath, tiredness, palpitations, dizziness, or passing out with or without concurrent AT/AF. Symptom-rhythm correlation (SRC) was calculated for each patient. Additionally, AT/AF-Symptom association was evaluated at the event level using multivariable mixed effects logistic regression. ResultsWe identified 742 patients with qualifying AECG data; mean age was 64 years, 50% were female, 22% had heart failure, and mean CHA2DS2-VASc score was 2.5. There were 6,289 symptomatic events and 6,900 ATAF episodes. Among symptomatic events 1013(16%) had shortness of breath, 839(13%) tiredness, 2640(42%) palpitations, 783(12%) dizziness, and 93(1%) with passing out. Overall SRC was 0.39(range 0-1.0), but presence of ATAF increased odds of symptoms by ∼8.3 times in adjusted analyses(p<0.01). In multivariable analysis, prior AF rhythm control treatment and lower heart rate were associated with worse SRC(p<0.01). ConclusionWhile ATAF events increase the chances of symptoms, there is poor overall correlation between symptomatic events and documented ATAF. Patient factors and prior treatments influence symptom-rhythm correlation. An improved understanding of this relationship correlation is needed to optimize clinical outcomes and improve the rigor of AF research.