Abstract:

Atrial fibrillation (AF) is a common heart rhythm abnormality characterized by disorganized atrial activity and irregular ventricular contraction. AF should be diagnosed with ambulatory ECG monitoring if AF-like activity lasts more than 30 s. The term “micro-AF” defines episodes of ≥5 consecutive supraventricular beats and complete absence of P waves lasting less than 30 s. We present the case of very short episodes of AF-like activity recorded with ambulatory ECG monitoring. A 50-year-old man visited a cardiologist for recurrent episodes of fast irregular heartbeat. 72-hour ambulatory 12-lead ECG monitoring revealed four episodes of AF that lasted more than 30 seconds. The longest episode lasted for 29 minutes. Also, there were two episodes of AF-like activity lasting for 17.2 s and 4.8 s. However, the majority of the episodes of AF-like activity lasted less than 4 seconds. The shortest episode of AF-like activity lasted for 0.8 seconds and included 5 obvious f-waves with a rate close to 340 bpm and one QRS complex. Also, there were episodes of obvious ultra-short AF-like activity lasting less than 1.6 seconds and resulted in only 3 QRS complexes. Such episodes cannot be classified as micro-AF as at least 5 QRS complexes are needed. Clinicians should always pay attention to ultra-short episodes of AF, as they may coexist with underdiagnosed long episodes of AF. A special term to define ultra-short episodes of AF-like activity should be introduced.

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