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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Subclinical Atrial Fibrillation: To Anticoagulate or Not?

Sharath Kommu1,2, Param P Sharma3

  • 1Department of Hospital Medicine, Marshfield Clinic Health System, Rice Lake, WI 54868, USA.

Journal of Clinical Medicine
|June 19, 2024
PubMed

Insights

Subclinical atrial fibrillation (SCAF) detection is common with new monitors. Anticoagulation with DOACs may reduce stroke risk but increases bleeding, requiring careful patient-doctor decisions.

Area of Science:

  • Cardiology
  • Clinical Electrophysiology
  • Stroke Prevention

Background:

  • Atrial fibrillation (AF) increases stroke risk, often requiring anticoagulation.
  • Implantable/wearable monitors frequently detect subclinical AF (SCAF) or atrial high-rate episodes (AHREs).
  • The benefit of anticoagulation for SCAF remains uncertain.

Purpose of the Study:

  • To evaluate the necessity of anticoagulation in patients with SCAF.
  • To analyze recent randomized controlled trials (NOAH-AFNET 6, ARTESIA) and their meta-analysis regarding SCAF treatment.

Main Methods:

  • Review of data from NOAH-AFNET 6 and ARTESIA trials.
  • Study-level meta-analysis combining trial data.
  • Assessment of stroke risk reduction versus major bleeding risk with anticoagulation.

Main Results:

  • Direct oral anticoagulants (DOACs) significantly reduce ischemic stroke risk.
  • DOACs may decrease the risk of debilitating strokes.
  • Anticoagulation with DOACs is associated with an increased risk of major bleeding.

Conclusions:

  • Anticoagulation in SCAF patients offers stroke risk reduction but carries a higher bleeding risk.
  • Shared decision-making is crucial, balancing stroke prevention benefits against bleeding risks.
  • Individualized treatment strategies are essential for managing SCAF patients.

Keywords:
DOACanticoagulationatrial fibrillationatrial high-rate episodes (AHRE)implantable heart monitorsmart watchsubclinical atrial fibrillation (SCAF)wearable heart monitor

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