The incidence of asymptomatic paroxysmal atrial fibrillation in patients treated with propranolol or propafenone

Progressive Nature of Paroxysmal Atrial Fibrillation-Observations From a 14-Year Follow-up Study-

“…27 Another disadvantage of the rhythm-control is unawareness of asymptomatic PAF. 20 The present results also support the limitations of the rhythm-control strategy from the longerterm viewpoint. In almost all cases PAF is a gradually progressive disease, even with apparently effective antiarrhythmic treatment, which can become poorly responsive to the treatment.…”

“…[13][14][15][16][17][18] In the short-term, PAF could be suppressed by antiarrhythmic drugs, but might not be prevented completely 12 and this incompleteness of the conventional antiarrhythmic therapy might promote remodeling and make the AF more refractory. These possibilities are supported, in part, by the existence of asymptomatic PAF, 19,20 which is more common than expected, 19 although it partially alleviated by the use of antiarrhythmic drugs. 12,19 Previous investigators have shown ischemic heart disease and valvular disease as independent risk factors for AF, [21][22][23] and aging and increased left atrial size have been also identified as important risk factors.…”

Asymptomatic or “Silent” Atrial Fibrillation

“…If antiarrhythmic drugs make atrial fibrillation less symptomatic by slowing the heart rate during arrhythmias or shortening periods of arrhythmia, then antiarrhythmic therapy might simply convert symptomatic arrhythmia episodes into asymptomatic ones. 18 -21 Wolk et al, 18 using 24-hour ambulatory monitors in patients with paroxysmal atrial fibrillation treated with propranolol and propafenone, showed that atrial fibrillation was frequent among patients who remained asymptomatic on this therapy; 4 of 18 (22%) patients receiving propranolol and 7 of 26 (27%) receiving propafenone recorded atrial fibrillation without symptoms.…”

Efficacy of Antiarrhythmic Drug Therapy in Preventing Recurrence of Atrial Fibrillation and Long-Term Cardiovascular Prognosis in Patients With Asymptomatic Paroxysmal Atrial Fibrillation

“…When the effect of antiarrhythmic drug therapy was evaluated by an ambulatory 24-hour monitoring analysis, it was confirmed that new asymptomatic AF had an incidence of approximately 22-27% during treatment with antiarrhythmic drugs that had pharmacological effects such as inhibition of atrioventricular conduction (propafenone and propranolol), and the effects were considered to be due to slow ventricular contraction and shortening of AF duration. 16) When the prophylactic efficacy of flecainide on paroxysmal AF was assessed by transtelephonic electrocardiography before and after flecainide administration, it was observed that new asymptomatic AF had an incidence of 11% after administration. 17) However, according to the French multicenter study, the incidence of asymptomatic AF in patients with chronic (permanent) AF was 16.2%, which was higher than that (5.4%) for paroxysmal AF.…”

“…According to a subanalysis of the recent AFFIRM study, the percentage of men was lower and the incidence of other complications (including ischemic heart disease, heart failure, peripheral vascular disease, pulmonary disease, and thyroid disease) was lower in patients with asymptomatic AF. 16) The onset of asymptomatic AF may be influenced by arrhythmia-related factors, including heart rate during AF and duration, pattern of onset, and time of onset of arrhythmia. When the effect of antiarrhythmic drug therapy was evaluated by an ambulatory 24-hour monitoring analysis, it was confirmed that new asymptomatic AF had an incidence of approximately 22-27% during treatment with antiarrhythmic drugs that had pharmacological effects such as inhibition of atrioventricular conduction (propafenone and propranolol), and the effects were considered to be due to slow ventricular contraction and shortening of AF duration.…”