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Subclinical Atrial Fibrillation in Older Patients.

Jeff S Healey1, Marco Alings2, Andrew Ha2

  • 1From Population Health Research Institute, Hamilton, ON, Canada (J.S.H., J.W., D.L., H.D., K.S., S.R.M., S.J.C.); McMaster University, Hamilton, ON, Canada (J.S.H., J.W., D.L., H.D., W.F.M., S.R.M., A.S.P., S.J.C.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); WCN-Dutch Network for Cardiovascular Research (M.A.); University of Toronto, ON, Canada (A.H., A.V.); University of Western Ontario, London, Canada (P.L.-S.); University of Ottawa Heart Institute, ON, Canada (D.H.B.); Nij Smellinghe Hospital, Drachten, the Netherlands (J.J.d.G.); Ikazia Ziekenhuis, Rotterdam, the Netherlands (M.F.); Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada (F.P.); University of Alberta, Edmonton, Canada (W.B.); University of Calgary, AB, Canada (M.D.H.); St. Jude Medical, Sylmar, CA (M.C.); Slingeland Ziekenhuis, Doetinchem, the Netherlands (F.S.); and Cambridge Cardiac Care Centre, ON, Canada (A.S.P.). Jeff.Healey@phri.ca.

Circulation
|August 6, 2017
PubMed
Summary

Subclinical atrial fibrillation (SCAF) is common in older patients without a history of AF, detected via continuous ECG monitoring. Further research is needed to understand the clinical significance of these SCAF findings.

Keywords:
atrial fibrillationmonitoring, physiologicstroke

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Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Subclinical atrial fibrillation (SCAF) prevalence is known in pacemaker and cryptogenic stroke patients.
  • SCAF prevalence in other patient groups without these conditions remains unknown.

Purpose of the Study:

  • To investigate the prevalence of SCAF in older patients without a history of atrial fibrillation attending cardiovascular or neurology clinics.

Main Methods:

  • Implanted subcutaneous ECG monitors (St. Jude CONFIRM-AF) in patients ≥65 years.
  • Included patients with CHA 2 DS2 -VASc score ≥2, sleep apnea, or BMI >30 kg/m2.
  • Eligibility also required left atrial enlargement or elevated NT-proBNP; monitored for SCAF ≥5 minutes.

Main Results:

  • SCAF was detected in 34.4% of 256 patients over 16.3 months.
  • Predictors of SCAF included older age, larger left atrial dimension, and blood pressure.
  • SCAF detection rate was higher in patients with left atrial volume above the median.

Conclusions:

  • SCAF is frequently detected in older outpatient cardiology and neurology clinic attendees without prior AF history.
  • The clinical significance of detected SCAF remains unclear.