Markers for silent atrial fibrillation in esophageal long-term electrocardiography

Purpose: Paroxysmal atrial fibrillation (PAF) often remains undiagnosed. Long-term surface ECG is used for screening, but has limitations. Esophageal ECG (eECG) allows recording high quality atrial signals, which were used to identify markers for PAF. Methods: In 50 patients (25 patients with PAF; 25 controls) an eECG and surface ECG was recorded simultaneously. Partially A-V blocked atrial runs (PBARs) were quantified, atrial signal duration in eECG was measured. Results: eECG revealed 1.8%o of atrial premature beats in patients with known PAF to be PBARs with a median duration of 853 ms (interquartile range (IQR) 813-1836 ms) and a median atrial cycle length of 366 ms (IQR 282-432 ms). Even during a short recording duration of 2.1 h (IQR 1.2-17.2 h), PBARs occurred in 20% of PAF patients but not in controls (p = 0.05). Left atrial signal duration was predictive for PAF (72% sensitivity, 80% specificity). Conclusions: eECG reveals partially blocked atrial runs and prolonged left atrial signal duration two novel surrogate markers for PAF. (C) 2016 Elsevier Inc. All rights reserved.