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Device-detected atrial fibrillation: what to do with asymptomatic patients?

Carol Chen-Scarabelli1, Tiziano M Scarabelli2, Kenneth A Ellenbogen3

  • 1Veterans Affairs Ann Arbor Health Care System, University of Michigan, Ann Arbor, Michigan.

Journal of the American College of Cardiology
|January 24, 2015
PubMed

Insights

Subclinical atrial tachyarrhythmias (ATs) detected by devices increase stroke risk. Guidelines recommend stroke risk assessment and anticoagulation for nonvalvular atrial fibrillation (AF) to prevent thromboembolic events.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Neurology

Background:

  • Atrial fibrillation (AF) is a prevalent arrhythmia associated with significant stroke risk.
  • Subclinical atrial tachyarrhythmias (ATs) detected by cardiac implantable electronic devices (CIEDs) are linked to thromboembolic events.
  • Clinical management of device-detected AT often involves delayed treatment or continued surveillance.

Purpose of the Study:

  • To review the epidemiology of atrial fibrillation.
  • To discuss the mechanisms of stroke in patients with AF.
  • To examine the clinical implications of device-detected AF and its association with stroke risk.

Main Methods:

  • Literature review of epidemiological data on AF.
  • Analysis of mechanisms linking AF to thromboembolic events.
  • Discussion of current clinical practice guidelines and device-detected AF management.

Main Results:

  • AF increases stroke risk irrespective of symptoms.
  • Device-detected ATs are associated with a higher risk of thromboembolic events.
  • Current guidelines recommend stroke risk stratification using CHA2DS2-VASc score for nonvalvular AF.

Conclusions:

  • Oral anticoagulation is recommended for nonvalvular AF with CHA2DS2-VASc score ≥2.
  • Device-detected AF warrants careful consideration for stroke prevention strategies.
  • Further research and updated clinical approaches are needed for managing device-detected ATs.

Keywords:
atrial tachyarrhythmiascardiac implantable electronic devicescerebral embolismdefibrillatorimplantable cardiac monitorstroke

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