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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Predicting Determinants of Atrial Fibrillation or Flutter for Therapy Elucidation in Patients at Risk for
Javed M Nasir1, William Pomeroy2, Adam Marler2
1Stanford University, Stanford, California; Keesler Medical Center, Biloxi, Mississippi.
Insights
Screening for atrial fibrillation (AF) in high-risk patients using insertable cardiac monitors (ICMs) detected new-onset AF in 22.4%. Most diagnosed patients received oral anticoagulant therapy, indicating ICMs
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Atrial fibrillation (AF) is a common cardiac arrhythmia and a major cause of stroke.
- Oral anticoagulants (OACs) significantly reduce stroke risk in AF patients.
- Optimal AF screening strategies and patient populations remain undetermined.
Purpose of the Study:
- To evaluate the CHA2DS2-VASc score for predicting new-onset AF using insertable cardiac monitors (ICMs).
- To determine if AF screening with ICMs leads to OAC initiation.
Main Methods:
- Prospective evaluation of 245 subjects with CHA2DS2-VASc score ≥2 and no prior AF history.
- AF screening using ICMs programmed for ≥6-minute episodes, with 18-month follow-up.
- Adjudication of events by cardiologists and review of subsequent OAC therapy.
Main Results:
- A 22.4% incidence of new-onset AF was detected during a mean follow-up of 451 days.
- The mean time to AF detection was 141.3 days.
- 76.4% of newly diagnosed AF patients were prescribed OACs.
Conclusions:
- In high-risk individuals (CHA2DS2-VASc ≥2), ICM screening identified new-onset AF in 22.4%.
- The majority of patients diagnosed with AF were initiated on OAC therapy.
- Insertable cardiac monitors show promise for AF screening in selected populations.
Background:
Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown.
Objectives:
In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy.
Methods:
We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care.
Results:
During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%-27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4).
Conclusion:
In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening.
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