Background
Wider availability of continuous rhythm monitoring has made feasible the incorporation
of metrics of atrial fibrillation (AF) burden and duration into the decision to initiate
anticoagulation. However, the relationship between thresholds of burden and duration
and underlying risk factors at which anticoagulation should be considered remains
unclear.
Objective
The purpose of this study was to evaluate the relationships of these metrics with
each other and the outcome of stroke/transient ischemic attack (TIA).
Methods
We identified patients with cardiovascular implantable electronic devices (CIEDs)
with atrial leads who had at least 1 interrogation in 2016 demonstrating nonpermanent
AF and were not receiving oral anticoagulation (OAC). We evaluated the relationship
between burden (ie, percentage of time spent in AF), the longest single episode of
AF, and risk factors (ie, CHA2DS2-VASc score) in predicting risk of stroke/TIA.
Results
The study included 384 patients with mean follow-up of 3.2 ± 0.8 years and incidence
of stroke/TIA of 14.8% during follow-up (∼4.6% per year). The burden of AF and the
duration of longest episode demonstrated a significant positive correlation to each
other but not CHA2DS2-VASc score. Importantly, although the CHA2DS2-VASc score was predictive of stroke/TIA, neither burden nor duration was associated
with stroke/TIA.
Conclusion
Among patients with CIED-detected AF not receiving OAC, the amount of AF (measured
by either burden or duration) does not seem to significantly impact stroke risk, whereas
CHA2DS2-VASc score does. These data suggest that among patients with CIED-detected AF, once
AF occurs, stroke risk seems to be predominantly driven by underlying risk factors.
Keywords
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Article Info
Publication History
Published online: October 23, 2020
Footnotes
Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Disclosures: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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