Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS)

Abstract

Asymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.

Frequent premature ventricular contractions. Association of burden and complexity with prognosis according to the presence of structural heart disease

“…Frequent PVCs are usually defined as the presence of at least one PVC on a 12‐lead ECG or >30 PVCs per hr (Al‐Khatib et al., 2018). But although this is a widely accepted guideline, in most of the studies assessing the impact of the PVC burden on the left ventricular dysfunction, the reported PVC burden is above 10% and usually higher than 20% of total beats (Arnar et al., 2019). Thus, higher than the PVC burden of our population and much higher than the PVC burden reported by Dukes and Argawal.…”

“…Premature ventricular contractions (PVCs) are a common finding during long‐term monitoring (Arnar et al., 2019). Although PVCs can occur in healthy persons, they are more frequent in the presence of structural heart disease (SHD), sleep apnea (Marinheiro et al., 2019), chronic obstructive pulmonary disease, and hyperthyroidism or stimulants (Einvik et al., 2017).…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

“…Sustained focal atria tachycardia in the adult population is usually associated with a benign prognosis, although tachycardia‐mediated cardiomyopathy has been reported in up to 10% of patients referred for ablation of incessant SVT 526 . Non‐sustained atrial tachycardia is frequently found on Holter recordings and often does not require treatment; however, we should consider that patients with a high premature atrial contractions (PAC) burden (>500/24 h) are at increased risk for developing of AF and be educated on the symptoms of AF 527 …”

Development and psychometric testing of the self-care scale for patients with chronic atrial fibrillation (AF-SCS-10)

“…2 AF is associated with increased complications such as systemic embolism, stroke, heart failure, and other hemodynamic dysfunctions, which can lead to increased hospitalization and medical costs. 3,6 Treatment for AF is determined by type, severity of symptoms, underlying disease, and patient's preference. 7 Antiarrhythmic drug therapy, a first-line treatment, has potential side effects, while anticoagulation therapy requires control and management of stroke risk and potential bleeding.…”