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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.Chest. 2010; 137: 263-272
- Atrial fibrillation, arrhythmia burden and thrombogenesis.Int J Cardiol. 2012; 157: 318-323
- A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation.Heart Rhythm. 2013; 10: 315-319
- Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care.J Am Coll Cardiol. 2004; 43: 47-52
- Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: the KP-RHYTHM study.JAMA Cardiol. 2018; 3: 601-608
- Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT.Eur Heart J. 2017; 38: 1339-1344
- The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk.Circ Arrhythm Electrophysiol. 2009; 2: 474-480
- How much atrial fibrillation is too much? Treatment benefit of anticoagulation based on threshold of device-detected AF.J Am Coll Cardiol. 2019; 73: 290
- Subclinical atrial fibrillation and risk of stroke: past, present and future.Medicina (Kaunas). 2019; 55: 611
- Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST).Circulation. 2003; 107: 1614-1619
- Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers.J Am Coll Cardiol. 2005; 46: 1913-1920
- Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis.Eur Heart J. 2018; 39: 1407-1415
- Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices).Eur Heart J. 2013; 35: 508-516
- Clinical implications of brief device-detected atrial tachyarrhythmias in a cardiac rhythm management device population.Circulation. 2016; 134: 1130-1140
- Atrial failure as a clinical entity.J Am Coll Cardiol. 2020; 75: 222-232
- Atrial myopathy.JACC Basic Transl Sci. 2019; 4: 640-654
- Stroke risk assessment in atrial fibrillation: risk factors and markers of atrial myopathy.Nat Rev Cardiol. 2016; 13: 549-559
- Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring.Stroke. 2011; 42: 1768-1770
- Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events.J Cardiovasc Electrophysiol. 2009; 20: 241-248
- Clinical implications of brief device-detected atrial tachyarrhythmias in a cardiac rhythm management device population: results from the Registry of Atrial Tachycardia and Atrial Fibrillation Episodes.Circulation. 2016; 134: 1130-1140
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.
Identification
Copyright
© 2020 Heart Rhythm Society. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Cardiac implantable electronic device-detected atrial fibrillation—“To anticoagulate or not to anticoagulate, that is the question”: The noble or ignoble choice?Heart RhythmVol. 18Issue 3
- PreviewAtrial fibrillation (AF) detected during interrogation of a cardiovascular implantable electronic device (CIED) is a common event,1 with available studies suggesting that it is associated with an increased risk of stroke.2,3 While current guidelines recommend oral anticoagulant (OAC) therapy for patients with AF and an elevated CHA2DS2-VASc score,4 controversy exists about whether the various components of CIED-detected AF (eg, duration, burden, and CHA2DS2-VASc score) predict stroke and, if effective as predictors, which characteristics best define that risk.
- Full-Text
- Preview
