Effectiveness of Atrial Fibrillation Monitor Characteristics to Predict Severity of Symptoms of Atrial Fibrillation

The goal of treatment for atrial fibrillation (AF) is often to control symptoms. It remains unclear whether targets for treatment such as AF rate or AF burden are correlated with AF symptom severity. Two hundred eighty-six patients completed a questionnaire of their general health and well-being, including a detailed AF symptom assessment immediately followed by a 7-day continuous monitor. AF characteristics assessed from the monitor included AF burden, AF rate, sinus rhythm rate, frequency and severity of pauses, and premature atrial contraction or premature ventricular contraction burden. Characteristics were analyzed separately for patients with paroxysmal or persistent AF. Symptom severity was assessed using the University of Toronto Atrial Fibrillation Severity Scale. Monitor characteristics were compared with AF symptom severity. The mean age of the cohort was 61.8 years and the majority of subjects were male (65.4%). Co-morbidities included hypertension (64.5%), sleep apnea (38.4%), congestive heart failure (19.6%), and diabetes (16.4%). In those with persistent or paroxysmal AF, there were no significant predictors of AF symptom severity. Specifically, heart rate in AF or sinus rhythm, AF burden, or premature atrial contraction or premature ventricular contraction burden was not predictive of AF symptom severity. After adjusting for potential cofounders (including age, gender, and co-morbidities), these findings persisted. In conclusion, there is no value in using AF monitor characteristics to predict symptoms in patients with AF.