QJM Advance Access originally published online on April 1, 2008
QJM 2008 101(6):506-507; doi:10.1093/qjmed/hcn046
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It is important to identify the presence of atrial fibrillation more accurately
Sir,It may be misleading to state that ‘the duration of atrial fibrillation was significantly longer among the group with diabetes’ than in non-diabetics1 when, on the basis of the author's own admission, their own measure of the duration of atrial fibrillation (AF) ‘may not reflect the true arrhythmia duration in all cases’.1 Chief among the reasons for the impossibility of knowing the arrhythmia duration in many of the cases is the fact that, in an unknown proportion of patients with AF, the arrhythmia is asymptomatic.2
It is also misleading to state that 63.7% of patients remained in sinus rhythm when seen in the first follow-up clinic1 without having undertaken regular documentation of heart rhythm so as to detect asymptomatic as well as symptomatic episodes of AF in the interval between the day of cardioversion and the day of the first outpatient follow-up.
The recommendation from a recent consensus conference is that the assessment of rhythm and other electrocardiogram-based (ECG-based) outcome parameters in patients who have undergone cardioversion from AF to sinus rhythm should meet the following requirements2:
- All ECG recordings should be analysed blind-to-treatment in a core laboratory.
- Every perceived (symptomatic) episode of AF should trigger an ECG.
- Additional, and mandatory, regular ECG recordings include either 24 h/month Holter ECG, or daily 30–60 s short-term ECG recordings.
- Any ECG-documented AF episode which lasts longer than 30 s should be reported as recurrent AF.
Finally, given the importance of the relationship between hypertension, diabetes, and atrial fibrillation3 the definition of hypertension should be compliant with the one given by the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure, which states that stage 1 hypertension is a systolic blood pressure in the range 140–159 mmHg and/or a diastolic blood pressure in the range 90–99 mmHg.4 Accordingly, under the ‘definitions’ heading, the blood pressure readings of >160/90 mmHg documented in the study1 should be categorised as stage 2 hypertension.4
Manchester Medical Society
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email: oscarjolobe{at}yahoo.co.uk
References
1. Soran H, Younis N, Currie P, et al. Influence of diabetes on the maintenance of sinus rhythm after a successful direct current cardioversion in patients with atrial fibrillation. Q J Med (2008) 101:181–7.[Web of Science]
2. Kirchhof P, Auricchio A, Bax J, et al. Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organised by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J (2007) 28:2803–17.
3. Aksnes TA, Schmieder RE, Kjeldsen SE, et al. Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial). Am J Cardiol (2008) 101:634–8.[CrossRef][Web of Science][Medline]
4. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 Report. Am J Cardiol (2003) 289:2560–72.
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