CARDIAC-RHYTHM AND SYSTEMIC EMBOLI DURING LONG-TERM FOLLOW-UP OF PATIENTS WITH NONVALVULAR PAROXYSMAL ATRIAL-FIBRILLATION

Background: Paroxysmal atrial fibrillation may predispose to systemic embolism. There is little information about the evolution of cardiac r hythm and the occurrence of new embolic events in these patients. Aim: To report the results of a long term follow up of patients with parox ysmal atrial fibrillation. Patients and methods: Patients consulting f or non valvular paroxysmal atrial fibrillation were followed for a mea n period of 5 years. An EKG, 2D echocardiogram and brain CT scans were performed on admission and at the end of the follow up period of all patients. Results: Sixty eight patients aged 65 +/- 1.5 years were stu died. Thirty two had an idiopathic atrial fibrillation, 28 had a histo ry of mild hypertension and 8 had a history of coronary artery disease . Evidence of systemic embolic was found in 17 patients at entry (to t he brain in 14 patients). During the follow up 87% of patients require d antiarrhythmics, 27% were anticoagulated and 28% received aspirin. F ive patents had new embolic episodes. Of these, four had a history of prior embolism. Forty one percent of patients continued in sinus rhyth m and remained asymptomatic, 32% had a least one recurrence of paroxys mal atrial fibrillation and nine patients evolved to chronic atrial fi brillation. Five patients required a permanent pacemaker due to sympto matic bradycardia. Conclusions: Most patients with non valvular paroxy smal atrial fibrillation remain in sinus rhythm but one third have rec urrences of the arrhythmia. A main risk factor for embolism is the his tory of previous embolic episodes.