Abstract
In patients with cardiac implanted electronic devices, detection of new atrial fibrillation (AF) is associated with an increased risk of stroke. To characterize daily AF burden at first detection and the rate of temporal transition to higher device-detected AF burden. A pooled analysis of data from 3 prospective projects was analyzed, and 6580 patients (mean age 68 ± 12 years, 72% male) with no history of AF and no use of anticoagulants at baseline were identified. Various thresholds of daily AF burden (5 minutes and 1, 6, 12, and 23 hours) were analyzed. Among the study population of 6580 patients, a new AF, with an AF burden of ≥5 minutes, was detected in 2244 patients (34%) during a follow-up period of 2.4 ± 1.7 years. Among these patients, 1091 (49.8%) transitioned to a higher AF-burden threshold during follow-up. A higher duration of daily AF burden manifest at first detection and CHADS2 score ≥2 were associated with faster transition to a subsequent higher burden. Approximately 24% of patients transitioned from a lower threshold to a daily AF burden of ≥23 hours during follow-up. More than one-third of patients with no history of AF developed device-detected AF, with attainment of different thresholds of daily AF burden over time. Continuous long-term monitoring, especially when the initial detection corresponds to a higher daily AF burden and the CHADS2 score is ≥2, could support timely clinical decisions on anticoagulation by capturing transitions to higher AF-burden thresholds.
Highlights
The extensive monitoring capabilities of cardiac implanted electrical devices (CIEDs) with sensing of atrial activity currently allow the detection of episodes of atrial high rate events (AHRE) episodes known as subclinical atrial fibrillation (SCAF)1–3 .The relationship between the duration of AHREs and the risk of stroke is complex and is an area of active investigation[4–6] Device-detected AF is associated with an increased risk of stroke,[1,3,7,8] but the precise threshold of device-detected AF that may justify initiation of oral anticoagulation (OAC) in patients with a clinical profile at risk, is not yet understood.[3,9]
Patient characteristics and occurrence of device detected AF burden during follow up A group of 6580 patients implanted with a cardiac implanted electronic devices (CIEDs) without history of AF and no OAC use at baseline were identified and followed for 2.4±1.7 years
Our study shows that the burdens of device-detected atrial tachyarrhythmias are not homogeneous with transitions from lower to higher AF burden categories depending on the AF burden at first detection, gender, and CHADS2 score
Summary
The extensive monitoring capabilities of cardiac implanted electrical devices (CIEDs) with sensing of atrial activity currently allow the detection of episodes of atrial high rate events (AHRE) episodes known as subclinical atrial fibrillation (SCAF)1–3 .The relationship between the duration of AHREs and the risk of stroke is complex and is an area of active investigation[4–6] Device-detected AF is associated with an increased risk of stroke,[1,3,7,8] but the precise threshold of device-detected AF that may justify initiation of oral anticoagulation (OAC) in patients with a clinical profile at risk, is not yet understood.[3,9]Current guidelines recommend risk-based prescription of OAC in patients with clinically documented AF.[10]. Several different thresholds of daily AF burden (for example, 56 minutes, 1, 6, 12 and 23 hours) have been investigated in patients with CIEDs and an association with an increased risk of stroke has been demonstrated.[11,12]. In patients with cardiac implanted electronic devices (CIEDs) detection of new atrial fibrillation (AF) is associated with an increased risk of stroke. Results: Among the study population of 6580 patients, a new AF, with a AF burden of at least 5 min, was detected in 2244 patients (34%) during a follow up of 2.4±1.7 years Among these patients 1091 (49.8%) transitioned to a higher AF burden threshold during follow-up. Continuous long-term monitoring, especially when the initial detection corresponds to a higher daily AF burden and the CHADS2 score is 2 or more, could support timely clinical decisions on anticoagulation by capturing transitions to higher AF burden thresholds
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