Problems in pharmacological evaluation of patients with paroxysmal atrial fibrillation: Clinical analysis of more than 100 consecutive patients

To address the problems of pharmacological evaluation in paroxysmal atrial fibrillation (PAf), we interviewed 108 consecutive patients with documented PAf symptoms, frequency and trigger factors of PAf and analyzed the 24-hou r ambulatory electrocardiographic monitoring (Holter monitoring) records in relation to symptoms. Twenty-nine patients were totally asymptomatic, whil e 79 patients were symptomatic of which 49 patients had obvious trigger fac tors. PAf was documented by Holter monitoring in 22 of 79 symptomatic patie nts. On analysis of PAf-documented 25 Holter monitoring records, the patien ts checked event marks as PAf in only 20 of 155 PAf episodes. Six episodes of 26 event marks that patients thought to be PAf proved to be premature at rial or ventricular contractions. Nine patients in whom PAf persisted for m ore than 24 hours became asymptomatic, Patients suitable for pharmacologica l evaluation constituted about one-fifth of the PAf patients in our consecu tive study. Even with the selection of these patients, pharmacological eval uation based on symptoms is difficult because disappearance of PAf may be a ssociated with persistent atrial fibrillation.