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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
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Atrial high-rate episodes and stroke prevention
A John Camm1, Emmanuel Simantirakis2, Andreas Goette3
1Department of Clinical Cardiology, St George's University of London, London, UK.
Summary
Oral anticoagulants (OACs) are proven for stroke prevention in atrial fibrillation (AF). Research is ongoing to determine if OACs benefit patients with atrial high-rate episodes (AHRE), a subclinical AF detected by devices, for stroke risk reduction.
Area of Science:
- Cardiology
- Electrophysiology
- Neurology
Background:
- Oral anticoagulants (OACs) are established for stroke prevention in diagnosed atrial fibrillation (AF).
- Atrial high-rate episodes (AHRE), or subclinical AF, are detected by cardiac implantable electronic devices but their link to stroke is unclear.
- Patients with AHRE show increased stroke risk compared to those without, but lower than diagnosed AF patients.
Purpose of the Study:
- To investigate the indication for OAC therapy in patients with AHRE.
- To determine if OACs reduce stroke risk in patients with subclinical AF detected by devices.
- To clarify the prognostic significance of AHRE and its relationship to AF.
Main Methods:
- Observational studies and ongoing clinical trials are evaluating stroke rates in patients with and without AHRE.
- Analysis of data from cardiac implantable electronic devices to detect and characterize AHRE.
- Comparison of stroke incidence in patients with AHRE undergoing OAC therapy versus those not on OACs.
Main Results:
- Patients with AHRE have a higher risk of stroke than those without AHRE.
- The stroke rate in AHRE patients appears lower than in patients with clinically diagnosed AF.
- Not all detected AHRE episodes definitively represent AF, complicating clinical interpretation.
Conclusions:
- The role of OACs in patients with AHRE remains uncertain.
- Further clinical trials are necessary to establish the efficacy and safety of OACs for stroke prevention in AHRE.
- Understanding the pathological significance of AHRE is crucial for guiding therapeutic decisions.
Keywords:
Atrial fibrillationStrokeThromboembolic riskAtrial high-rate episodesSubclinical atrial fibrillationParoxysmal atrial fibrillationAnticoagulationCardiovascular implantable electronic devicesMore Related Videos
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